HR Forms

The ITD HR Unit has posted certain forms concerning personnel matters online for ease of accessibility. To access a form, just click on the form's link and print it out for completion.

FORMS

DESCRIPTION

LEAVES

Leaves of Absence Packet

These forms must be completed for absences more than 20 consecutive work days

Employee/Contractor Exit Checklist

Use this form to determine if an employee/contractor has returned all district property prior to leaving the District.

FMLA - Certification by Health Care Provider Certification Employee or Family Member Serious Health Condition

Certification by health care provider of employee's or family members serious health condition.

FMLA Current Service Member 2015

Certification for Serious Injury or Illness of a

Current Servicemember For Military Family Leave

Certification of Qualifying Exigency

For Military Family Leave

Veteran For Military Family Leave

PAYROLL

Absence Request Form-Illness

Certification/Request of absence for illness, family illness, or new child

Absence Request Form-Non Illness

Certification/Request of absence for non-illness

Absence Request Form-Coronavirus Response Act

Certification/Request of absense for Families First Coronavirus Response Act

California Form DE 4 - Employee's Withholding Allowance Certificate

Complete this State of California form to designate withholding from your pay.

Change of Address Form

Complete this form if your home address has changed.

Deceased Employee Notice

Form to notify of employee death.

Overtime Request Form

Complete this form to request overtime in advance for classified and non-management employees.

Payroll Service Request Form

Request for service regarding payroll issues.

W-4: Employee's Withholding Allowance Certificate

Complete this IRS form to designate withholding from your pay.

Z Time Request Form

Complete this form to request the use of employees on unassigned days “outside” of their calendar basis.

MISCELLANEOUS

Access Badge Request (LAUSD)

Form to request a LAUSD badge

Checklist for Reporting Death

Assist family members with reporting an employee's death.

Employment Information Form

Complete this form at the time of the first assignment and every time the employee changes job classifications.

Freeze Form

Request for freeze exemption:  Staffing

New Health Insurance Marketplace Coverage Options and Your Health Coverage

This memo provides information on the Affordable Care Act (ObamaCare)

OEHS Injury-Accident Investigation Report

This report must be completed within 24 hours of an accident involving an injury to students, employees or visitors.

Personnel Request Form

Complete this form to request personnel to fill a  vacancy.

Pre-Designation Physician Form

This form contains personal physician information.  It must be maintained at the work location in the employee’s personnel file.

Property Registration Form

Complete this form to register personal property brought by employees for use in schools or offices.

Request for Bilingual Differential

Language differential request for bilingual skills.

Request for Change of Assignment

Request to change assignment.  This is NOT a transfer request form.

Request for Reinstatement

Request to reinstate for employees who resigned in good standing.

Resignation Form for Classified Employees

Complete this form if you are resigning.

Temporary Employment Application

Application for temporary assignments.

Transfer Request Form

Request to change work location.

Vehicle Accident Report

Vehicle Accident Report Form

Workers Comp Injury Report Worksheet

Complete this worksheet when a work-related injury or illness occurs.