Forms Library
- Benefit Forms
- New Employee Forms
- Payroll Forms
- Recruitment Forms
- Safety Forms
- Classified Forms
- Faculty Forms
- Part Time Faculty Forms
- Management Forms
Benefit Forms
- ADA Accommodation Forms
- Health Insurance Forms
- New Insurance Enrollment Application (for new employee enrollments)
- Mid-Year Insurance Enrollment Change Form(link is external) (for changes to existing enrollments)
If enrolling a domestic partner, please also complete the OEBB Affidavit of Domestic Partnership(link is external).
If removing a domestic partner because of separation, please complete the OEBB Termination of Domestic Partnership(link is external).
- Health Savings Account Enrollment/Change Form (for classified and management employees enrolled in Moda Medical Plan 6)
- Leave of Absence and PFML/OFLA/FMLA Forms
- Request for Leave of Absence(link is external)
- Certification of Health Care Provider for Employee's Serious Health Condition(link is external) - required when a leave request is due to the medical condition of the employee
- Certification of Health Care Provider for Dependent's Serious Health Condition(link is external) - required when a leave request is due to the medical condition of the employee’s family member
- PFML Claim for Parental Leave(link is external)
- PFML Claim for Employee's Serious Health Condition(link is external)
- PFML Claim for Family Member's Serious Health Condition(link is external)
- Attestation for Affinity Relationship(link is external)
- Life Insurance Beneficiary Designation
- MyOEBB(link is external) portal
- Medicare Notification - Creditable Rx Coverage
- PERS Forms
- Salary Reduction Agreement Forms
- Tax Sheltered Annuities - 403(b) Deduction Authorization Form(link is external)
- Deferred Compensation - 457 Deduction Authorization Form (.pdf) (.doc)
- Section 125 Forms
- Claim Form - access via the My Benefits online portal(link is external) or through the P&A Group My Benefits mobile app
- Direct Deposit Form - access via the My Benefits online portal(link is external) or through the P&A Group My Benefits mobile app
- Enrollment Form
- Letter of Medical Necessity(link is external)
- Tuition Waiver Forms
- Part-time Employee Tuition Waiver
- Family Tuition Waiver
- Retiree Tuition Waiver(link is external)
- Goshen Fire Department Tuition Waiver (.pdf) (.doc)
- College Now High School Teacher Tuition Waiver (.pdf) (.doc)
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New Employee Forms
- FERPA Statement(link is external)
- Information Confidentiality Statement(link is external)
- New Employee Policy and Procedure & Mandatory Training Checklist
- Vector LMS Account Request(link is external)
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Payroll Forms
- Confidentiality Statement
- Direct Deposit Authorization Form (.pdf) (.doc)
- Form I-9(link is external)
- Federal Form W-4
- Oregon Form W-4
- Oregon Form W-4 Instructions
- FERPA Form (The Family Educational Rights and Privacy Act of 1974) (.pdf)
- Journal Entries (.pdf) (.doc)
- Part Time Statement of Appointment(link is external)
- Personal Information Form (.pdf) (.doc)
- Personnel Action Form
- Personal Cell Phone Allowance Agreement (.pdf)
- Student Worker Documentation Form (.pdf) (.doc)
- Student Worker Consent to Disclose - Waiver of FERPA Rights Form (.pdf) (.doc)
- Waiver of Liability Form for Volunteers (.pdf) (.doc)
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Recruitment Forms
- Employment Recommendation Form (.pdf) (.doc)
- Recruitment Process (.pdf) (.xls)
- Recruitment Report (.pdf) (.doc)
- Redacted Application FAQ(link is external)
- Search Committee Agreement Form (.pdf) (.doc)
- Search Committee Confidentiality Form (.pdf) (.doc)
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Safety Forms
- Employee Accident/Incident Analysis Form(link is external)
- Workers' Compensation 801 Form(link is external) (choose the 801 form from the list) (fillable pdf)
- Mandatory Child Abuse Reporting FAQ
- New Employee Policy and Procedure Checklist (.pdf) (.doc)
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Classified Forms
- Classified Evaluation Forms
- Classification / Reclassification Process Forms
- Classified Step Advancement Form(link is external)
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Faculty Forms
- Faculty Certification Form
- Faculty Developmental Evaluation Forms
- Faculty Leave & Substitution Calculation - Article 32.6
- Faculty Pay Plan Change Request (.pdf) (.doc)
- Faculty Step Advancement Handbook (.pdf) (.doc)
- Request for RIF Report Review Form
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Part Time Faculty Forms
- Part Time Cancellation Process - Article 34.8
- Part Time Faculty Certification Form
- Part Time Faculty Evaluation Record Sheet (.doc)
- Part Time Placement Checklist Form (.doc)
- Part Time Statement of Appointment Form (.pdf) (.doc)
- Part Time Work Assignment - Article 34.2 (.pdf) (.doc)
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Management Forms
- Managers Performance Review Rating Scale Definition
- Performance Review Instrument (.pdf)
- Job Analysis Questionnaire (.pdf) (.doc)
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Lane Community College is an equal opportunity/affirmative action institution.