Fill - Free fillable Hiring Packet - ACADEMICADMINISTRATOR2017aug PDF form

Welcome!

New Academic Administrator

Welcome to Cerritos College! The following documents are required to process new

employees and to be approved by the Board of Trustees. Print and complete all forms and

return to Rebecca Pang in Human Resources by appointment only (562) 860-2451 ext. 2281.

Thank you.

Please bring the following documents with you to the Office of Human Resources:

☐ Current Photo ID (First and Last name must match name on Social Security card)

☐ Social Security card (original)

☐ Work Authorization (if applicable)

☐ Official college transcripts with degree confer date

☐ Proof of test for PPD-Tubersol/Mantoux (TB) or cleared chest X-ray within the last 3 ½ years

Forms to print, complete, and return:

☐ LiveScan memo and form –Cerritos College Campus Police fingerprints fee is $32

☐ I-9 Employment Eligibility

☐ Oath of Allegiance

☐ W-4 – Click on the link and complete the Employee's Withholding Allowance Certificate

☐ Emergency Contact

☐ Injury & Illness Prevention Program (IIPP) Acknowledgement form

☐ Workers’ Compensation Pre-Designation of Personal Physician

☐ Direct Deposit option– Provide a voided check with the completed form

☐ Mailing Warrants Authorization option

☐ Warrant Recipient Designation

☐ Cal STRS (Retirement) Permissive Membership

☐ Address & Phone Number Disclosure

☐ Retirement Questionnaire

☐ Staff Diversity Questionnaire

☐ Statement Concerning Your Employment in a Job Not Covered by Social Security

☐ Verification of Receipt

Keep the following forms for your reference:

 Academic Calendar

 Work Calendar

 Campus E-mail Instructions

 CCFF Letter

 AFT Membership

 Nondiscrimination

 BP 7050 Conflict of Interest Policy

 IIPP Packet

 Procedure for New Web

 AP 3720 Computer & Network Use Policy

 AP 3518 Child Abuse Reporting Policy

 Personal Safety on Campus

 Employee Feedback

 Rideshare Information Packet

 Parking Permit Instructions

 TB Memo & Referral

 AP 3050 Code of Ethics Policy

 Salary Schedule

 New Hire Pamphlet

 Employee Assistance Brochure

 STRS Handbook Link & Beneficiary Form

 Links to CSEA and CCFF Bargaining Agreements

CERRITOS COLLEGE

EMORANDUM

MEMO TO: New Academic Employees

FROM: Dr. Adriana Flores-Church, Director of Human Resources/

Risk Management

SUBJECT: LIVE SCAN FINGERPRINT PROCESSING

As a condition of employment, it is required that new academic employees be

fingerprinted for processing a background investigation through the State Department of

Justice (Bureau of Criminal Identification).

In order to comply with this policy it is required that you do the following:

1. Complete the attached Request for Live Scan Services.

2. Take the completed form to the Cerritos College Campus Police

Department to obtain Live Scan fingerprinting services.

If you have any questions, please contact the college Human Resources office at (562)

860-2451, Ext. 2284.

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE

BCII 8016

(orig. 4/01; rev. 6/09)

REQUEST FOR LIVE SCAN SERVICE

Applicant Submission

ORI (Code assigned by DOJ)

Authorized Applicant Type

Type of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned)

Contributing Agency Information:

Agency Authorized to Receive Criminal Record Information Mail Code (five-digit code assigned by DOJ)

Street Address or P.O. Box

City State ZIP Code

Contact Name (mandatory for all school submissions)

Contact Telephone Number

Applicant Information:

Last Name First Name Middle Initial Suffix

Other Name

(AKA or Alias)

Last First Suffix

Date of Birth

Sex

Male

Female

Driver's License Number

Height Weight Eye Color Hair Color

Place of Birth (State or Country)

Social Security Number

Home

Address

Street Address or P.O. Box City State ZIP Code

Billing

Number

(Agency Billing Number)

Misc.

Number

(Other Identification Number)

Your Number:

OCA Number (Agency Identifying Number)

Level of Service:

DOJ FBI

If re-submission, list original ATI number:

(Must provide proof of rejection)

Original ATI Number

Employer (Additional response for agencies specified by statute):

Employer Name

Street Address or P.O. Box

City State ZIP Code

Mail Code (five digit code assigned by DOJ

Telephone Number (optional)

Live Scan Transaction Completed By:

Name of Operator Date

Transmitting Agency LSID ATI Number Amount Collected/Billed

ORIGINAL - Live Scan Operator SECOND COPY - Applicant THIRD COPY (if needed) - Requesting Agency

A1548

Employment

Academic Employee

Cerritos College Human Resources Department

13749

11110 Alondra Blvd

Norwalk

CA 90650

driana Flores-Church

(562) 860-2451

143197

Academic = $32.00

External Links to

Complete

Employment Eligibility Verification Form I-9

Please Click Here to Retrieve Form I-9

Form W-4

Please Click Here to Retrieve Form W-4

Thank you

Y: Forms: Oath of Allegiance

OATH OF ALLEGIANCE FOR PERSONS EMPLOYED BY

PUBLIC AGENCIES IN THE STATE OF CALIFORNIA

(Government Code Section 3102)

I, __________________________________, do solemnly swear (or affirm) that I will support and

defend the Constitution of the United States and the Constitution of the State of California

against all enemies, foreign and domestic; that I will bear true faith and allegiance to the

Constitution of the United State and the Constitution of the State of California; that I take this

obligation freely, without any mental reservation or purpose of evasion; and that I will well and

faithfully discharge the duties upon which I am about to enter.

____________________________________ ___________________________________

Signature of Employee Title of Position

Taken, subscribed and sworn to before me this ______ day of __________________, 20______

___________________________________ ___________________________________

Signature of Administrator Title

This oath must be signed by a Cerritos Community College District administrator involved in the

hiring and payroll process of management, faculty, classified, and student assistance employees

of the District

EMPLOYEE ADDRESS/TELEPHONE/EMERGENCY CONTACT INFORMATION

EMPLOYEE ADDRESS/TELEPHONE INFORMATION

Last Name First Name MI

Home/Mailing Address

Home Phone Number Cell Phone Number

EMPLOYEE TYPE (CHECK ONE):

Full-Time Faculty

Confidential

Part-Time Faculty

Management

Classified

Signature of Employee Date

EMERGENCY CONTACT INFORMATION

Please provide the name(s) of a person(s) (and other information requested below) the District

should contact in case of an emergency (serious injury, sudden illness, etc.).

Last Name First Name MI Relationship

Home Address City State Zip

Home Phone Number Work Phone/Cell Phone Number Place of Employment

Last Name First Name MI Relationship

Home Address City State Zip

Home Phone Number Work Phone/Cell Phone Number Place of Employment

The Cerritos Community College District Board of Trustees, the District, and its

management pledge

to support the Injury Illness Prevention Program (IIPP) and to

ensure that it remains a viable method

of protecting all employees and all other site

occupants, as well as to meet its obligations of

maintaining a safe and healthful work

place.

The IIPP is a basic written workplace safety program. Title 8 of the California Code of

Regulations

(T8CCR) section 3203, requires every employer to develop and implement

an effective IIPP. It is

the District's responsibility to communicate the IIPP to all its

employees and it is the employee's

responsibility to read and comply with the provisions

of the IIPP and health and safety regulations.

By signing this form, I acknowledge receipt of Cerritos College's Injury Illness

Prevention Program. I

understand that any questions about the IIPP or any safety

related concerns should be directed to the

Risk Manager, Site Manager, or

representative in the Safety Committee.

Employee's Full Name (print)

Date Employee's Signature

UPON COMPLETION OF THIS FORM,

FORWARD TO

HUMAN RESOURCES/RISK MANAGEMENT

Adriana Flores-Church, Ed.D.

Risk Management

(562) 860-2451 Ext 2283

Injury Illness Prevention Program

Acknowledgement Form

Form 122012

Cerritos College

Workers’ Compensation: Pre-Designation of Personal Physician

If you have health insurance and you are injured on the job you have the right to be treated immediately by your personal physician

(M.D., D.O), or medical group, if you notify your employer, in writing, prior to the injury. Per Labor Code 4600 to qualify as the your

predesignated, personal physician, the physician must agree, in writing, to treat you for a work related injury, must have

previously directed your medical care and must retain your medical history and records. Your predesignated physician must be a

family practitioner, general practitioner, board certified or board eligible internist, obstetrician-gynecologist or pediatrician. Your

“personal physician” may be a medical group if it is a single corporation or partnership composed of licensed doctors or medicine or

osteopathy, which operates an integrated multi-specialty medical group providing comprehensive medical services predominantly for

non-occupational illnesses and injuries.

This is an optional form that can be used to notify your employer of your personal physician. You may choose to use another form, as

long as you notify your employer, in writing, prior to being injured on the job and provide written verification that your personal

physician meets the above requirements and agrees to be predesignated. Otherwise, you will be treated by one of your employers’

designated workers’ compensation medical providers.

EMPLOYEE NAME: ______________________________________________________________________________

 I acknowledge receipt of this form and elect not to predesignate my personal physician at this time. I understand that I will receive

medical treatment from my employers’ medical provider. I understand that, at any time in the future, I can change my mind and

provide written notification of my personal physician. I understand that the written notification must be on file prior to an industrial

injury.

Employee Signature: __________________________________________________________ Date: ______________

 If I am injured on the job, I wish to be treated by my personal physician

me of Physician or Medical Group ________________________________________ Phone Number ___________________

Address _________________________________________________________________________

*This physician is my personal primary care physician who has previously directed my medical care and retains my medical history and

records.

Employee Signature: __________________________________________________________ Date: ______________

A Personal Physician must be willing to be predesignated and treat you for a workers’ compensation injury.

The remainder of this form is to be completed by your physician and returned to your Employer.

P E R S O N A L P H Y S I C I A N A C K N O W L E D G E M E N T

Per Labor Code 4600 to qualify you must meet the criteria outlined above. You are not required to sign this form, however, if you or your

designated employee, does not sign, other written documentation of the physicians’ agreement to be predesignated will be required

pursuant to Title 8, California Code of Regulations, section 9780.1(a)(3).

PERSONAL PHYSICIAN OR MEDICAL GROUP NAME: _________________________________________________________

 I agree to treat the above named employee in the event of an industrial accident or injury

. I meet the criteria outlined above. I

agree to adhere to the Administrative Director’s Rules and Regulations, Section 9785, regarding the duties of the employee-

designated physici

an.

 I do not agree

to treat the above employee in the event of an industrial accident or injury.

 I do not qualify as the employees’ personal physician. I am not an M.D. or D.O. or do not meet the criteria outlined above.

______________________________________________________ _______________________

(Physician or Designated Employee of the Physician or Medical Group) Date

Please return completed form to:

Cerritos College  11110 Alondra Blvd., Norwalk, CA 90650  (562) 860-2451

Cerritos College Employee’s Direct Deposit

Information and Instructions

1. Direct depos

it is a voluntary program which will transfer your net pay directly

to your checking

or savings account.

Instead of a pay warrant, you will receive an advice of the

amount

dep

osited attached to your pay stub. The entire net check amount must be deposited, a

the deposit can only be direct to one checking or savings account per employee.

2. Things to

consider:

 Your bank, S&L, or credit union must be a member of a National Automa

ted

Clearinghouse Associati

on, which mo

st institutions are.

 A garnishment order will temporarily suspend direct deposit s

atus.

 If you have more than one assignment with the District on regular payroll cycles, all

pay

will go direct

deposit.

 Retroa

ctive checks and adjustments checks which are paid on a suppleme

ntal

schedule, wi

ll not be direct deposited. When regular pay is reissued on a supplement

schedule, you will receive an actual payroll

warrant.

3. How to sign up:

 Complete E

mployee’s Direct Deposit Authorization form. Attach a voided ch

eck for

verifying routing numbers and/or account numbers.

 Return

the completed form to the Payroll Offi

 Payroll will

enter the information in the county’s payroll system for a test run.

advice (direct deposit) will issue for $0.00 which will be forwarded to the employee.

 Employee

should verify the account number for accuracy. If there is a

discrepancy,

please conta

ct the Payroll Office immediat

ely.

 The

first check to be direct deposited will be on or after the start-up date in

dicated on

the pre-n

otifi

cation.

4. Submit a new authorization form to Payroll when:

 you cha

nge the name on the account

 you close the account or move the account from one branch to another

 you are absent for more than a semester or year

5. Additional provisions (Please read carefully):

 Employees will be responsible for any fees, charges or costs assessed by Los Angele

unty Office of Education and/or my bank institution due to my failure to cancel

modify my Direct Deposit Authorization. Such fees, charges or costs will be deducted

from my payroll warrant.

 Employees understand and agree that a replacement payroll warrant will not be issued

to said employee, or on behalf of said employee, if a Direct Deposit Authorization is

invalidated by a transfer of banking account(s) or banking institution until/unless Los

Angeles County Office of Education has confirmed the receipt of the returned

funds/payroll warrant. Please not the return of incorrect Direct Deposit funds could

delay issuance of a replacement payroll warrant for approximately 10 to 15 working

days.

Direct deposit is not automatically canceled when you close the account to which your

pay is being deposited. You must cancel direct deposit with the Payroll Office before you

close the account at the financial institution.

Cancelling your direct deposit can be accomplished via email to the Payroll Office.

dhart@cerritos.edu

jthein@cerritos.edu

(Deanna Hart, Payroll Manager)

(John Thein, Payroll Technician)

(Barbara Young, Payroll Technician)

(Karla Duarte, Payroll Techncian)

bjyoung@cerritos.edu

kduarte@cerritos.edu

Payroll Unit

deposits and, as necessary, debit corrections to previous deposits to my account.

I understand:

Direct deposit status is not activated until 10 days following a Direct deposit will also be suspended if a a certificated

$0 test transaction for new or change authorization. employee's credential expires.

I must submit a new Employee's Direct Deposit Authorization, Direct deposit status may be suspended or rescinded by

Form No. 501-508, if I change my account the district or LACOE and payment made by county

(name, institution, branch, type account, etc.). warrant, if necesasry, to meet payroll deadlines or under

extreme conditions.

Direct deposit status will be temporarily suspended if wages

are garnished.

I agree to hold harmless and indemnify the district and Los Angeles County Office of Education and its officers, employees, and agents

from any claim or demand of whatever nature, including those based upon negligence of LACOE and its officers, employees, and

agents for failure or delay in making deposits and/or corrections to deposits as herein authorized.

This authorization replaces any previously made by me and is to remain in effect until changed or canceled by submission of a new

Employee's Direct Deposit Authorization.

ATTACH BELOW A VOIDED CHECK

SHOWING THE INSTITUTION ROUTING

NUMBER AND ACCOUNT NUMBER.

SIGNATURE OF EMPLOYEE

DATE SIGNED

ATTACH VOIDED CHECK HERE

FOR COUNTY OFFICE USE ONLY

Refer to the Direct Deposit Reference Guide

INPUT BY (PRINT NAME)

GR 9/2007

FINA NCI AL I NSTI TUT ION RO UTIN G NO.

PLEASE CHECK

ew Change

Direct Deposit Authorization

PRINT LAST NAME, FIRST NAME, MIDDLE INITIAL SOCIAL SECURITY NUMBER

AME OF SCHOOL DISTRICT (IF EMPLOYED WITHIN THE OFFICE, PUT YOUR ROOM NUMBER HERE) WORK TELEPHONE NUMBER

(

)

AME OF BANK/CREDIT UNION/SAVINGS & LOAN BRANCH TELEPHONE NUMBER

(

)

Checking

Savings

ACCOUNT NUMBER ADDRESS OF BANK/CREDIT UNION/SAVINGS & LOAN (NUMBER,STREET,CITY AND ZIP CODE)

I hereby authorize the district and the Los Angeles County Office of Education (LACOE) and/or its agents to initiate electronic

Cancel

EMPLOYEE'S DEPOSIT ACCOUNT NO.

Cerritos Community College District

562

860-2451

Cerritos Community College District

Authorization for Mailing Payroll Warrants

This form must be completed and submitted to the District Payroll Department if you

wish to have your payroll warrants mailed to you at your home (mailing) address at the

District's expense. Please complete the following information:

Name

Please Print

(Last) (First) (MI)

Division/Department

Full-Time Faculty Part-Time Faculty Management

Classified Confidential Student/Adult Hourly

I understand that this authorization applies to all warrants (regular, part-time, overload,

summer school, and/or student/adult hourly). No deviation will be made from the

method of delivery authorized herein for the remainder of this academic year. Changes

in the method of delivery of warrants can only be made at the beginning of a new

academic year unless otherwise approved by the Payroll Department.

The warrants will be mailed on the same day on which they are received from the Los

Angeles County Office of Education.

Please Note: The District is not responsible for payroll warrants lost in the mail. It

is the employee's responsibility to notify the District of changes of address.

Date Signature of Employee



The following section is to be used only for the purpose of an employee requesting to

rescind his/her authorization for mailing of payroll warrants.

I hereby request that the District discontinue the mailing of my

payroll warrants as previously authorized.

Name

Please Print (Last) (First) (MI)

Division/Department

Full-Time Faculty Part-Time Faculty Management

Classified Confidential Student/Adult Hourly

Date Signature of Employee

WARRANT RECIPIENT DESIGNATION

In accordance with the provisions of Section 53245 of the California Government Code, in the event

of my death, I hereby designate the following persons (designees) to receive any and all warrants

payable to me.

Designee #1

Name ___________________________________________ Relationship: _______________________

Address: ______________________________ City: ____________________ State: ____ Zip: _______

OR, in the event of the death of Designee #1,

Designee #2

Name ___________________________________________ Relationship: _______________________

Address: ______________________________ City: ____________________ State: ____ Zip: _______

This designation form cancels and replaces any designation form previously signed for this purpose

and shall remain in effect until cancelled in writing by me.

It is understood and agreed that the Cerritos Community College District is not obligated to deliver

said warrants to the designee unless the designated person claims such warrants from the District

and provides sufficient proof of identity. A person so designated may negotiate the warrant(s) as if

the payee.

Employee Name (print): _____________________________________________

Employee Signature: ______________________________________ Date: _____________

Management Faculty Classified Short-Term Hourly

School District/Agency: Cerritos Community College District

Submit this completed form to the Office of Human Resources

PeopleSoft: ___________

CERRITOS COMMUNITY COLLEGE DISTRICT

RETIREMENT STATUS QUESTIONNAIRE FOR ACADEMIC PERSONNEL

Name:

Gender:

Male

Female

Maiden Name:

Social Security Number:

Date of Birth:

Address:

Telephone:

MPLOYMENT STATUS

FULL-TIME

PART-TIME

SUBSTITUTE

OTHER

CREDENTIAL HELD (TYPE)

EXPIRATION DATE

What year did you first teach in California Public Schools?

Where?

In what county did you last teach?

In what District did you last teach?

When?

RETIREMENT STATUS

1. Are you a member of the State Teachers’ Retirement System? ____________

Have you withdrawn your retirement funds? ______. If yes, give date of withdrawal. __________.

Have you redeposited these funds? ____________

Are you contributing into the State Teachers’ Retirement System in any other District? _______. If y

es,

here? ___________________________________

Full-Time ______ or Part-Time ______. What was the effective date of your membership into the

System? ___________________________.

Are you a member of the California Public Employees’ Retirement System? ______ Have you withdraw

our retirement funds? _________. If yes, give date of withdrawal. __________. Have you redeposited

these funds? _______________

Are you contributing into the California Public Employees’ Retirement System in any other state or

governmental agency? _____. If yes, where? ___________

Full-Time _______ or Part-time _______. What was the effective date of your membership into th

ystem? ________________________.

Are you employed in any other District during this school year? ____. If so, list:

County

District

Regular

% of Full-Time

Sub

Hourly

PLEASE PROVIDE A SUMMARY OF ALL PRIOR ACADEMIC (CERTIFICATED) EMPLOYMENT IN THE

APPROPRIATE SPACE BELOW, GIVING BEGINNING MONTH AND COUNTIES IN CALIFORNIA:

School

Year

Month

County

School

Year

Month

County

School

Year

Month

County

94-95

04-05

95-96

05-06

86-87

96-97

06-07

87-88

97-98

07-08

88-89

98-99

08-09

89-90

99-00

09-10

90-91

00-01

10-11

91-92

01-02

11-12

92-93

02-03

12-13

93-94

03-04

13-14

In acco

rdance with the provisions of the California State Education Code:

1. If

you are a member of the State Teachers’ Retirement System, each District in which you are

employed must deduct an amount equivalent to eight percent (8%) of your salary earned.

2. If you are not a member, you will become a member by rendering 100 full days of service in a District

as a substitute employee within a school year.

3. If you are a part-time hourly employee (not substituting), you become a member by serving 60 hours or

more in a pay period in a District. If employed on a part-time daily basis you become a member by

serving 10 or more days in a pay period in a District.

4. Employees will also qualify for membership if they serve 600 or more hours on a substitute hourly

basis.

5. Employees filling a vacancy created by the death or resignation of an employee become members of

STRS as of the first day of such service and deductions must be taken.

6. Part-time employees, who serve less than 60 hours or 10 days per pay period and substitutes, may

elect IRREVOCABLY to become members of the System.

7. Acceptance of employment in a position requiring membership in the system is your consent to

have deductions from salary taken for the system.

8. It is the employee’s responsibility to notify the District of any changes in his/her employment or

retirement system status through other employing Districts to insure that appropriate deductions from

salary warrants for retirement system plans and also District payments for such plans on behalf of the

employee are made. Failure to do so on the part of the employee may result in retroactive salary

deductions to correct such errors.

gnature Date

Revised 6/16

14-15

15-16

Permissive Membership

ES 0350 (Rev. 6/11)

PERMISSIVE ELECTION AND ACKNOWLEDGEMENT OF RECEIPT

OF CALSTRS DEFINED BENEFIT PLAN MEMBERSHIP INFORMATION

California State Teachers’ Retirement System

P.O. Box 15275, MS 17

Sacramento, CA 95851-0275

800-228-5453

CalSTRS.com

An employee who performs creditable service (Education Code Section 22119.5), and who is excluded from mandatory membership pursuant to

Section 22601.5, 22602, or 22604, may elect membership in the California State Teachers’ Retirement System (CalSTRS) Defined Benefit

Program at any time while employed to perform creditable service. If you elect membership below, then your election becomes irrevocable until

you terminate employment. This form containing your election must be on file with CalSTRS before your employer submits contributions into the

program.

EMPLOYEE CERTIFICATION

NAME (LAST, FIRST, INITIAL) CLIENT ID OR SOCIAL SECURITY NUMBER

MAILING ADDRESS

POSITION TITLE

CITY STATE ZIP CODE HOME TELEPHONE

E-MAIL ADDRESS

With my signature below, I certify that I have received information from my employer on my eligibility to elect membership in CalSTRS Defined

Benefit Program and that I am making the following election. I fully understand this election is irrevocable and applies to all future creditable

service until I terminate employment.

I understand it is a crime to fail to disclose a material fact or to make any knowingly false material statements for the purpose of altering a

benefit administered by CalSTRS and it may result in penalties, including restitution, up to one year in jail and a fine of up to $5,000 (Education

Code Section 22010).

I elect membership  I decline membership at this time 

SIGNATURE DATE

TO BE COMPLETED BY EMPLOYER

With my signature below, I certify that the above-named employee has been provided with the membership criteria for the CalSTRS Defined

Benefit Program, and if applicable, was informed within 30 days of hire that they may elect membership in the Program at any time while

employed. (Education Code section 22455.5).

OFFICIAL’S SIGNATURE

TITLE

COUNTY (or Other Employing Agency)

DISTRICT

EMPLOYEE #

SEX

MALE FEMALE

BIRTHDAY

(MO/DAY/YEAR)

MEMBERSHIP DATE

(MO/DAY/YEAR)

ASSIGNMENT

PT SUB

PERMISSIVE MEMBERSHIP • REV 06/11

Cerritos Community College

Los Angeles

Cerritos Community College District

Staff Diversity Information Questionnaire

This form is to be completed by all employees of the District. This information is required by the

District for research, evaluation, and federal/state reporting purposes. Please print and check

the appropriate boxes to provide the following information:

Name:

Gender:

Male

Female

(Last, First, MI)

Date of Birth:

Month/Day/Year

Ethnic Group (with which you most closely identify):

Asian or Pacific Islander

Hispanic/Latino

Chinese

Hawaiian

Mexican, Mexican-American, Chicano

Japanese

Guamanian

Central American

Filipino

Samoan

South American

Korean

Laotian

Other Hispanic

Vietnamese

Cambodian

Asian Indian

Pacific Islander Other

Asian Other

American Indian/Alaskan Native

African American/Black

Caucasian/White

Disabilities - Substantially limited to one or more major life activities and having a

record of a vision, mobility, hearing, speech, learning or mental impairment or being

regarded as having such impairment.

None

Yes, please identify

Vietnam Era Veteran (August 4, 1964 - May 5, 1975):

Yes

List any relative(s) employed by the District:

Name

Position

Division/Department

Relationship

Signature of Employee

Date

2014

Y:\Beryl_Donna\Processing Forms for New Hires\Management Receipt Info.doc 03/14

Cerritos Community College District

Verification of Receipt of New Employee Information

(Management Employees)

I hereby certify that I have received the following items from the Human Resources office as part of my

new employment processing:

Academic & Fiscal Calendars

Identification Card (Staff)

Board Policies – Available on President’s webpage

Management Salary Schedule

Campus Map

Non-Discrimination Policy & Procedures Brochure

Campus E-mail Instructions

Computer & Network use Administrative Policy

CCFF Collective Bargaining Agreement

Personal Safety on Campus Brochure

CSEA – District Collective Bargaining Agreement

and Administrative Regulations

Personal Physician Designation Form

(Work Related Injury) & New Hire Pamphlet

Classified Employees’ Handbook

Public Employees’ Retirement System Member

Handbook

Confidential Employees’ Handbook

(Supplement to Classified Employees’ Handbook)

Request for Transfer of Sick Leave

Conflict of Interest Notice

Rideshare Bulletin

Direct Deposit Information (Pay Warrant)

Staff Parking Permit Instructions (Verbal)

Employee Assistance Program Brochure

State Teachers’ Retirement System

Handbook/Beneficiary Designation Form

Faculty Handbook Verbal Instructions

(Faculty Handbook available online only)

Student Health & Wellness Center Brochure

Employee Feedback Form

Tuberculin Test Memorandum

AP 3050 Institutional Code of Ethics

Injury Illness Prevention Program

AP 3518 Child Abuse & Neglect Reporting

Employee Name (Print)

Signature of Employee

Date

Signature of Human Resources Office

Date

CAMPUS E-MAIL INSTRUCTIONS

(Classified & Confidential Employees)

1. Contact division/department secretary or

your immediate manager to make sure

request has been made for you to have

access to the computer system.

2. Get your user ID and temporary password

from either the division/department

secretary or your immediate manager.

3. Call the innovation center at extension

#2797 to set up a training appointment.

The innovation center will train you on how to

gain access into the computer system and your

email account.

6/1/17

Cerritos College  Academic Calendar 2017-2018

SUMMER SESSION – 2017

May 22 – August 11

May 29 Memorial Day

July 4 Independence Day

FALL SEMESTER – 2017

August 14 – December 15

August 14 – October 13 First 9-Week Session

September 4 Labor Day

September 5 – December 15 15-Week Intrasession

October 16 – December 15 Second 9-Week Session

November 10 Veteran’s Day

November 23 – 26 Thanksgiving

December 9 – 15 Final Exams

SPRING SEMESTER – 2018

January 8 – May 18

January 2 – 5 Flex Week

January 8 – March 9 First 9-Week Session

January 15 Martin Luther King, Jr.’s Birthday

January 29 – May 18 15-Week Intrasession

February 16 Lincoln’s Birthday

February 19 Washington’s Birthday

March 12 – March 18 Spring Recess

March 19– May 18 Second 9-Week Session

May 12 – 18 Final Exams

SUMMER SESSION – 2018

May 21 – August 10

May 28 Memorial Day

July 4 Independence Day

Dates are subject to renegotiation if the District adopts a

compressed calendar.

May 2017

S M T W T F S

1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

July 2017

S M T W T F S

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 .31

August 2017

S M T W T F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

September 2017

S M T W T F S

1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

October 2017

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

November 2017

S M T W T F S

1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30

January 2018

S M T W T F S

1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

February 2018

S M T W T F S

1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28

March 2018

S M T W T F S

1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

April 2018

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

May 2018

S M T W T F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

July 2018

S M T W T F S

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

August 2018

S M T W T F S

1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

June 2017

S M T W T F S

1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30

December 2017

S M T W T F S

1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

June 2018

S M T W T F S

1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

Legend

Semester Start Days

Semester End Days

Holidays

S M T W TH F S S M T W TH F S

1 1 2 3 4 5 6 Jul 4 Independence Day

2 3 4 5 6 7 8 7 8 9 10 11 12 13

9 10 11 12 13 14 15 14 15 16 17 18 19 20 Sep 4 Labor Day

16 17 18 19 20 21 22 21 22 23 24 25 26 27

23 24 25 26 27 28 29 28 29 30 31 Nov 10 Veteran's Day

30 31

Nov 23 Thanksgiving Day

S M T W TH F S S M T W TH F S

1 2 3 4 5 1 2 3 Nov 24 Board Approved Holiday

6 7 8 9 10 11 12 4 5 6 7 8 9 10 (Friday after Thanksgiving)

13 14 15 16 17 18 19 11 12 13 14

15 16 17

20 21 22 23 24 25 26 18 19 20 21 22 23 24 Dec 22 Board Approved Holiday

27 28 29 30 31 25 26 27 28

Dec 25 Christmas Day

Dec 26 Board Approved Holiday

S M T W TH F S S M T W TH F S

1 2 1 2 3 Dec 27 Board Approved Holiday

3 4 5 6 7 8 9 4 5 6 7 8 9 10

10 11 12 13 14 15 16 11 12 13 14 15 16 17 Dec 28 Board Approved Holiday

17 18 19 20 21 22 23 18 19 20 21 22 23 24

24 25 26 27 28 29 30 25 26 27 28 29 30 31 Dec 29 Board Approved Holiday

Jan 1 New Year's Day

S M T W TH F S S M T W TH F S Jan 15 Dr. Martin Luther King, Jr. Day

1 2 3 4 5 6 7 1 2 3 4 5 6 7

8 9 10 11 12 13 14 8 9 10 11 12 13 14 Feb 16 Abraham Lincoln Day

15 16 17 18 19 20 21 15 16 17 18 19 20 21

22 23 24 25 26 27 28 22 23 24 25 26 27 28 Feb 19 George Washington Day

29 30 31 29 30

Mar 16 Board Approved Holiday

(Friday of Spring Break)

S M T W TH F S S M T W TH F S May 28 Memorial Day

1 2 3 4 1 2 3 4 5

5 6 7 8 9 10 11 6 7 8 9 10 11 12

12 13 14 15 16 17 18 13 14 15 16

17 18 19

19 20 21 22 23 24 25 20 21 22 23 24 25 26

26 27 28 29 30 27 28 29 30 31

S M T W TH F S S M T W TH F S

1 2 1 2

3 4 5 6 7 8 9 3 4 5 6 7 8 9

10 11 12 13 14 15 16 10 11 12 13 14 15 16

17 18 19 20 21 22 23 17 18 19 20 21 22 23

24 25 26 27 28 29 30 24 25 26 27 28 29 30

Adopted by the Board of Trustees

January, 2018

February, 2018

March, 2018

September, 2017

May, 2018

November, 2017

December, 2017

June, 2018

May 3, 2017

Cerritos College

Mandated and Board Approved Holidays

July, 2017

August, 2017

April, 2018

October, 2017

2017-2018 Work Calendar

Annual Notice/2016

Cerritos Community College District

Nondiscrimination and Sexual Harassment

All members of the campus community, including you, have the right to work and study

in an environment free of discrimination and sexual harassment.

What is sexual harassment?

Board Policy 3430 contains the District’s zero tolerance policy against all forms of harassment, including sexual

harassment. Sexual harassment is a form of unlawful discrimination. District Board Policies, state and federal laws

prohibit all forms of unlawful discrimination.

Board Policy 3410 and Administrative Procedure 3410 describes the District’s commitment to nondiscrimination

and Administrative Procedure 3435 explains how reports and complaints of discrimination are filed and

investigated. You may contact the Office of Human Resource Services with questions and to make reports at (562)

860-2451, extension 2284.

The District’s Board Policies and Administrative Procedures may be found on the District’s website at

http://cms.cerritos.edu/board/policies/. Excerpts of District Board Policy 3410: Nondiscrimination, and Board

Policy 3430: Prohibition of Harassment are included below.

You should know that you have a duty to report discrimination or sexual harassment if:

 You have become aware of acts of discrimination or sexual harassment.

 You have witnessed acts of discrimination or sexual harassment.

 Any member of the campus community has reported acts of discrimination or sexual harassment to you.

If you need to ask questions, get information, or make a report, you may contact:

Ms. Frances Gusman

Interim Dean of Student Services

Student Activities Office

(562) 860-2451, extension 2476

fgusman@cerritos.edu

Mr. Harry Joel

Interim Vice President of Human Resources

Office of Human Resource Services

(562) 860-2451, extension 2280

hjoel@cerritos.edu

Dr. Stephen Johnson

Vice President, Student Services/

Assistant Superintendent

Student Services Office

(562) 860-2451, extension 2236

sjohnson@cerritos.edu

Dr. Lucinda Aborn

Dean, Disabled Student Programs and

Services (DSP&S)

DSP&S Office

(562) 860-2451, extension 2334

laborn@cerritos.edu

Individuals with concerns about discrimination or sexual harassment may also contact any manager for immediate

assistance. For disability concerns, please contact Dr. Mary Anne Gularte or Dr. Lucinda Aborn. If you are

interested in Sexual Harassment Training, you may contact the Office of Human Resource Services at (562) 860-

2451, extension 2284. Information concerning discrimination and complaints of discrimination can also be

obtained from:

U.S. Equal Employment California Department of Fair

Opportunity Commission Employment and Housing

www.eeoc.gov www.dfeh.ca.gov

Cerritos Community College District Policy No. 7050

Human Resources

BP 7050 EMPLOYEE CONFLICT OF INTEREST

References: 2

Government Code, Sections 1126, 82029, 87100, 87302; 3

CCR, Title 2, Section 18705 4

The following policy pertains to all employees of the Cerritos Community College 5

District. 6

A. CONFLICTS OF INTEREST ARE PROHIBITED 7

No employee or consultant/contractor of the Cerritos Community College District 8

shall make, participate in making, or in any way attempt to influence a decision of 9

the Cerritos Community College District in which he or she knows or has reason 10

to know will have a financial effect, distinguishable from its effect on the public 11

generally, on the employee or his or her “immediate family.” Immediate family 12

shall mean spouse and dependent children of an employee of the District 13

(Government Code, Section 82029), which includes: 14

1. Any business entity in which the employee, consultant/contractor or15

his/her immediate family has an investment;16

2. Any business entity in which the officer, employee, consultant/contractor17

or his/her immediate family is a director, officer, partner, trustee,18

employee, or holds any position of management; or,19

3. Any real property in which the officer, employee, consultant/contractor or20

his/her immediate family has a direct or indirect interest.21

B. USE OF CONTRACTORS 22

In accordance with Government Code, Section 1126, no designated employee 23

filing an Annual Statement shall accept money or gifts from any current 24

contractor providing facilities, grounds, or construction services to the District. 25

Designated employees are required to disclose on the Annual Statement any 26

money or gifts in any amount from any current contractor providing facilities, 27

grounds, or construction services to the District. For purposes of this section, a 28

‘current contractor’ refers to any business entity or individual including 29

contractors, suppliers, architects, attorneys, engineers, and insurers, providing 30

services related to the construction of facilities or grounds for the District during 31

the year covered by the Annual Statement. 32

C. PENALTIES 33

Any employee who shall make, participate in making, or in any way attempt to 34

use his or her relationship with the Cerritos Community College District to 35

influence a decision of the Cerritos Community College District in which he or 36

she knows or has reason to know he or she has a prohibited financial interest 37

shall be subject to discipline, including up to dismissal. 38

D. ACADEMIC DECISIONS 39

In the area of academic decisions, the Fair Political Practices Commission has 40

established certain specific exemptions from conflict of interest provisions which 41

are applicable to the Cerritos Community College District. Academic decisions 42

with respect to textbook utilization and other educational materials are also 43

subject to the District’s written guidelines for textbooks which appear in the 44

Faculty Handbook. The regulations for academic decisions adopted by the 45

California Fail Political Practices Commission, at Title 2 Code of the California 46

Code of Regulations (CCR), Section 18705, provide as follows: 47

Section 18705. Academic Decisions. 48

“(a) Except as provided in subsection (b), neither disclosure of financial 49

interests nor disqualification is required under Government Code, Sections 50

87100, 87302, or any Conflict of Interest Code, in connection with: 51

“(1) Teaching decisions, including the selection by a teacher of books or 52

other educational materials for use within his or her own school or 53

institution, and other decisions incidental to teaching; 54

“(2) Decisions made by a person who has teaching or research 55

responsibilities at an institution of higher education to pursue personally a 56

course of academic study or research, to apply for funds to finance such a 57

project, to allocate financial and material resources for such academic 58

study or research, and all decisions relating to the manner or methodology 59

with which such study or research will be conducted. Provided, however, 60

that the provisions of this subsection (2) shall not apply with respect to 61

institution- or campus- wide administrative responsibilities respecting the 62

approval or review of any phase of academic research or study conducted 63

at the institution or campus. 64

“(b) Disclosure shall be required under Government Code, Section 87302 65

or any Conflict of Interest Code in connection with a decision made by a 66

person or persons at an institution of higher education with principal 67

responsibility for a research project to undertake such research, if it is to 68

be funded or supported, in whole or in part, by a contract or grant (or other 69

funds earmarked by the donor for a specific research project or for a 70

specific researcher) from a nongovernmental entity, but disqualification 71

may not be required under Government Code, Sections 87100, 87302, or 72

any Conflict of Interest Code in connection with any such decision if the 73

decision is substantively reviewed by

an independent committee 74

established within the institution.” 75

E. DISTRIBUTION OF THIS POLICY 76

Copies of this policy shall be distributed by the Human Resources Office to all 77

current and future employees. 78

See also BP/AP 2710 titled Conflict of Interest and BP 2712 titled Conflict of Interest 79

Code. 80

Office of Primary Responsibility: Human Resources 81

Date Adopted: December 10, 2008

(Replaces former Cerritos CCD Policy 5000.1)

Cerritos College Campus Map

INJURY & ILLNESS

PREVENTION PROGRAM

Cerritos College

11110 Alondra Blvd.

Norwalk, CA 90650

(562) 860-2451

Page 2

TABLE OF CONTENTS

Injury & Illness Prevention Policy .................................................................................................................. 3

Definitions .......................................................................................................................................................... 3

Responsibilities ................................................................................................................................................... 4

Plan Review......................................................................................................................................................... 5

Occupational Safety & Health Work Practices – Compliance .................................................................... 5

Communication .................................................................................................................................................. 6

Evaluation, Investigation, & Correction of Workplace Hazards ................................................................ 7

Employee Training ............................................................................................................................................ 9

Recordkeeping .................................................................................................................................................. 10

Reporting Job-related injuries/illness ........................................................................................................... 10

APPENDIX I ................................................................................................................................................... 11

Identification of District IIPP Coordinators

Page 3

INJURY AND ILLNESS PREVENTION POLICY

The District will develop and implement an Injury and Illness Prevention Program to meet its

obligations of maintaining a safe and healthful work place. The Cerritos Community College

District Board of Trustees, the District, and its management pledge to support this program and to

ensure that it remains a viable method of protecting all employees and all other site occupants, as

well as meet our compliance requirements.

DEFINITIONS

DISTRICT

The legal educational agency consists of Cerritos College.

WORKPLACE

References the area of operations to which an employee is assigned (i.e., Cerritos College or District

Services).

Page 4

RESPONSIBILITIES

The Injury and Illness Prevention Program (IIPP) Coordinator for the Cerritos Community College

District is the President/Superintendent. The President/Superintendent has designated the Risk

Manager as the IIPP District Coordinator and the Division Deans as the IIPP Site Coordinators

with site specific responsibility for the IIPP. The President/Superintendent is responsible for

ensuring that District policies and practices are implemented, employees are provided a safe and

healthful workplace, and that operations are in compliance with the Injury and Illness Prevention

Program and applicable federal, state, and local regulations and standards.

IIPP DISTRICT COORDINATOR

The Risk Manager is responsible for the IIPP and implementation of program requirements for the

District.

IIPP SITE COORDINATORS

The Division Deans are responsible for the IIPP and implementation of program requirements for

their divisions.

SITE MANAGER

The Administrators, Department Directors, and Managers are designated as site managers and are

responsible for ensuring that their direct reports and employees implement and follow the IIPP and

associated programs and practices required to meet all applicable regulatory requirements. The site

managers will be responsible for maintaining a safe and healthful workplace, conducting safety

inspections, and ensuring compliance with all Cal/OSHA and other applicable federal, state, and

local safety and health standards and regulations.

EMPLOYEES

Employees must comply with the provisions of the IIPP and health and safety regulations, promptly

report unsafe activities and conditions to management, and actively participate in safety and health

training and other related activities.

CONTRACTORS

Contractors must have their own IIPP and their program must complement the District’s IIPP.

Contractors must meet all regulatory requirements and actively participate in site health and safety

activities as required in contracts and purchase orders.

OTHERS UNDER THE PURVIEW OF THE IIPP

All others under the purview of this IIPP (e.g., associated student officers, student aides and hourly

employees) must comply with the provisions of the program and health and safety regulations,

promptly report unsafe activities and conditions to management, and actively participate in safety

and health training and other related activities.

VISITORS AND GUESTS

Visitors and guests must comply with site health and safety requirements and participate in IIPP

activities as required.

Page 5

PLAN REVIEW

The IIPP District Coordinator will be responsible for ensuring the IIPP is accessible via the

www.cerritos.edu website and it is reviewed at least once during the first year after implementation

and then at least annually, thereafter.

The review will be to ensure that the written plan is appropriate for the District at the time of the

review and for any anticipated future changes. The IIPP Site Coordinators will be required to

provide written notice to the IIPP District Coordinator. The IIPP District Coordinator will then

provide written notice to the President/Superintendent that the review was conducted and

communicate changes, suggested modifications, and improvements, if any.

OCCUPATIONAL SAFETY AND HEALTH WORK PRACTICES – COMPLIANCE

The President/Superintendent, through the IIPP District Coordinator and IIPP Site Coordinators,

will implement a system or systems to ensure that all employees comply with workplace safety and

health practices.

The system or combination of systems will include any one or combination of the following:

1. Training and retraining programs: training and retraining needs have been identified and

published in the annual schedule of safety and health training.

2. The IIPP procedure and updates pertaining to safety will be published annually.

3. Administrators and classified leadership will monitor ongoing p

erformance and participation

as required in the IIPP through the performance appraisal process as identified in the

administrative procedures and collective bargaining agreements.

Employees found violating workplace safety practices or found jeopardizing the safety of

any other employee, student, or visitor shall be subject to disciplinary action in accordance

with the existing District policies, administrative procedures, and collective bargaining

agreements. Disciplinary action shall be taken for violations of management directives, rules,

regulations, work practices, or policies. Any action taken will not violate employee rights

under Cal/OSHA regulations and will be enforced in a non-discriminatory fashion.

4. Safety and health procedures and practices will be published and communicated to

employees.

Page 6

COMMUNICATION

Communication to employees and between employees and the District on matters relating to

occupational safety and health is an important aspect of ensuring the success of the District’s Injury

and Illness Prevention Program. Therefore, through the IIPP District Coordinator and the IIPP

Site Coordinators, the District will implement a system or combination of systems intended to

accomplish the following:

1. Provide a means for the District to communicate to employees, in a readily understandable

form, matters relating to occupational safety and health; and

2. Encourage employees to inform the District Facilities Department of workplace safety

hazards

The communication portion of this IIPP will consist of any one or combination of the following:

1. TRAINING AND RETRAINING PROGRAMS. Safety training and retraining classes

provide a forum for the discussion of specific and general safety, health, and compliance

best practices.

2. MEETINGS. Site managers will conduct safety meetings or staff meetings, which may

include the discussion of safety issues or specific safety topics. These meetings are intended

to discuss one or more safety items and encourage open discussions between employees and

management.

3. SAFETY COMMITTEE. The Safety Committee is considered an important part of the

overall system of communication. The recommended committee make-up may include

representatives from the following:

• Administration

• Maintenance/Operations

• Students

• Academic Staff

• Classified Staff

• Safety and Security/Campus Police

• Faculty

• Expert Consultants

The Safety Committee will ensure that the following requirements are met:

a. The committee meets regularly, but not less than quarterly.

b. Minutes or written records are prepared for each meeting showing the safety and

health issues discussed. These records shall be made available to all affected

employees through the use of postings, newsletters, or other appropriate written

Page 7

materials. Records of the meetings will be kept on file and be accessible via the

www.cerritos.edu website for at least 5 years.

c. Reports of safety inspections, investigations of occupational accidents, and causes of

any incident resulting in injury, illness, or exposure to hazardous substances are

reviewed. Where necessary or appropriate, the committee will submit suggestions to

management for the prevention of future incidents.

4. ANONYMOUS NOTIFICATIONS. Notifications can be made in open forums or

training sessions, as well as through inter-departmental mail sent to management,

supervisors, union representatives, or Human Resources. Site Managers will submit all

anonymous notifications to the Safety committee.

5. MISCELLANEOUS. When appropriate, the District may use written communications

such as inter-District memos, electronic media, envelope stuffers, newsletters, and workplace

postings to supplement the previously described systems and further communicate to

employees matters relating to workplace safety and health.

EVALUATION, INVESTIGATION and CORRECTION OF WORKPLACE HAZARDS

A major component in the effectiveness of the Injury and Illness Prevention Program depends on

the ability to properly identify, evaluate, and correct workplace hazards. The main system for

identifying and evaluating workplace hazards will be ongoing evaluations, inspections, and meetings.

The purpose of these inspections and meetings will be to identify and correct unsafe conditions and

work practices.

Workplace inspections will be scheduled and can be conducted on an as needed basis using the

following criteria:

• An initial inspection when the program is first established;

• An inspection of affected areas whenever a new substance, process, procedure, or piece of

equipment that potentially presents a new occupational safety and/or health hazard is

introduced to the workplace;

• An inspection of affected areas whenever the management is made aware of a new or

previously unrecognized hazard; and

• When occupational illnesses and injuries occur, the IIPP Site Coordinator or designee will

conduct the investigation.

1. ONGOING INSPECTIONS. The annual workplace inspection is an important part of

the overall inspection program. Site Managers are responsible for ensuring safety

inspections are conducted per schedule. These inspections will be conducted with the

following considerations:

Page 8

a. The IIPP Site Coordinator in conjunction with the Site Manager will designate

management personnel conducting the inspections.

b. Inspections may be accomplished using check-off forms or other means of

documentation.

c. Copies of the completed check-off forms or other documents will be distributed as

follows:

• IIPP Site Coordinator

• Site Manager

• Safety Committee

2. ANNUAL INSPECTIONS. The District will use outside safety consultants to

supplement the in-house inspection program. Inspections by outside safety consultants will

be conducted annually. The party conducting the professional inspections must have

professional qualifications and safety expertise, e.g., Certified Safety Professional (CSP), a

professional member of the American Society of Safety Engineers (ASSE), or a registered

Professional Engineer (PE) in safety with demonstrated experience at educational

institutions and must carry liability insurance. Copies of consultant’s inspection reports will

be maintained at least 5 years at the District’s Business Office.

3. SAFETY ACTIVITIES. Job Safety Analysis (JSA), employee safety training, or issue

specific assessments (e.g., department ergonomic studies) may be used in lieu of or to

supplement the scheduled workplace inspections.

4. ACCIDENT INVESTIGATIONS. The injured employee’s immediate manager will

conduct the accident investigations to identify and correct unsafe conditions and practices.

These investigations will be conducted for all work-related injuries and illnesses resulting in

employees being unable to work.

5. CORRECTIONS OF UNSAFE OR UNHEALTHFUL CONDITIONS. Unsafe or

unhealthy work conditions, practices, or procedures shall be corrected in a timely manner

based on the severity of the hazards. Hazards shall be corrected according to the following

criteria:

a. When observed or discovered.

b. When an imminent hazard exists that cannot be immediately abated without

endangering employee(s) and/or property, all exposed employees, except those

properly trained or qualified to correct the existing condition, will be evacuated from

the area impacted.

c. Following an accident investigation or hazard assessment (e.g., JSA) when unsafe

acts or conditions are identified.

Page 9

d. When evidence of repeated unhealthful situation is documented and reported in

specific areas.

All such actions taken to correct hazards and corresponding dates of completion shall be

documented on the appropriate forms. The responsible Administrators, Deans, Directors,

and Managers shall be notified of unsafe conditions and corrective action recommended.

EMPLOYEE TRAINING

The IIPP District Coordinator and the IIPP Site Coordinators units will implement and maintain an

Occupational Safety and Health Training Program for their respective employees. The training

program is intended to train and instruct employees in general safety and health work practices, and

to provide instruction with regard to hazards specific or unique to each employee’s job.

The IIPP Site Coordinators shall ensure that all Site Managers are knowledgeable of the safety and

health hazards to which employees under their immediate direction and control may be exposed.

Employee training may include the following elements:

1. All employees will receive training and instruction when the Injury and Illness Prevention

Program is first established and when modifications and revisions are completed. All

employees will receive information on the IIPP at the time of hire.

2. All affected or potentially affected employees will receive appropriate safety training prior to

assignments, when potentially exposed to new hazards, when assigned new work tasks, or

when a new chemical/material, equipment, or process is introduced into the workplace.

3. Employees will receive refresher training when new or previously unrecognized hazards are

identified, when the District feels it is appropriate, or as mandated by regulatory

requirements.

4. Employees attending or receiving training mandated by this Program will sign attendance

sheets and actively participate in training.

5. Specific employee training will be determined/identified by the IIPP District Coordinator,

IIPP Site Coordinators, and the Site Managers in consultation with safety consultants. This

training will be designed to address department and task specific compliance and accident

prevention needs.

6. IIPP District Coordinator and District Workers’ Compensation Coordinators will receive

appropriate training to ensure compliance with OSHA regulations.

Page 10

RECORDKEEPING DUTIES

Records of hazard assessments, safety and hazard inspections, safety meetings, accident

investigations, and safety and health training for each employee will be maintained for at least 5

years.

The hazard assessments, health and safety inspections, and accident investigation records will

identify the person conducting the inspection/activity, any unsafe conditions or practices identified,

and the corrective action(s) taken to eliminate or control the hazard.

Health and safety training records shall include the name of the employees trained, date and type of

training provided, and the provider of the training.

Page 11

APPENDIX I

IDENTIFICATION OF PROGRAM MANAGERS

IIPP Coordinator President/Superintendent

IIPP District Coordinator Human Resources/Risk Management

IIPP Site Coordinators Instructional Dean, Business Ed/Humanities/Social Sciences

Instructional Dean, Fine Arts/Communications

Instructional Dean, Health Occupations

Instructional Dean, Liberal Arts

Instructional Dean, Physical Education/Athletics

Instructional Dean, Science, Engineering & Mathematics

Instructional Dean, Technology

Dean of Academic Affairs

Dean of Academic Success & Institutional Effectiveness

Dean of Admissions, Records & Services

Dean of Counseling

Dean of DSPS

Dean of Student Support Services

Dean of the Library, Special Programs & Services

Site Managers Exec Director of Foundation & Community Advancement

Director of Adult Education/Diversity Programs

Director of Advance Transportation Technology Project

Director of Career and Assessment Services

Director of Child Development

Director of Community Advancement

Director of Community Education

Director of Employment, Diversity & Legal Services

Director of Fiscal Services

Director of Foster & Kindship Care Educational Program

Director of Information Technology

Director of International Student Services

Director of Pathway Programs

Director of Physical Plant

Director of Public & Government Relations

Director of Purchasing

Director of Student Activities

Director of CalWORKS Services

Director or Research and Planning

Accounting Manager

Associate Dean of Student Health, Wellness & Veterans Services

Page 12

Budget Manager

Chief of Campus Police

EOPS Assistant Director

Facilities Manager

Manager of Information Technology

Operations Manager

Payroll Manager

PeopleSoft Database Administrator

Web Administrator

Cerritos College

Public Affairs

Procedure for a New Cerritos College Web

To r

equest a Cerritos College web:

1) Along with your dean or manager, request a new computer account from IT by submitting the

new computer account form found on the IT web, www.cerritos.edu/it

2) Request a new web from Samuel Chavez in Public Affairs at x2966 or schavez@cerritos.edu or

contact Ty Bowman at tbowman@cerritos.edu

and tell us your username or Cerritos email

address.

3) Set up a one-hour training appointment with Samuel Chavez to get started.

4) Refer to the Web Handbook, www.cerritos.edu/webhandbook

, to learn our standards,

understand your responsibilities as a web author and gain technical knowledge of how to use

the Cerritos Web Content Management System web authoring tool.

he web administration team is part of the Public Affairs department. We are responsible for all aspects

of the college’s public information web. Internally, we provide tools and training to Cerritos College

employees to allow you to update web page content easily. We are available to assist you with your

web site during the week via telephone, email and in person. Appointments are scheduled in the

Innovation Center (LRC201) to meet and discuss any questions or concerns you may have so please

don’t hesitate to contact us.

s a public institution, Cerritos College has mandates from the federal government and state of

California to follow Web accessibility guidelines also known as Section 508, www.section508.gov

. Every

employee has the responsibility to make sure that all pages and content associated with the Cerritos

College Web is accessible to persons with disabilities. The Cerritos College Board, President and

administrators have a long standing commitment to Web Accessibility which is seen as vital to student

success. Web content posted by any employee of the District that is used for college business is the

liability of Cerritos College no matter where the content resides. Web Administration is committed to

helping you create web pages that meet Web Accessibility guidelines and all Cerritos College web

standards.

ur goal is to assist you in helping students at Cerritos College succeed in their academic pursuits by

providing tools and training that enable you to provide information to all students via the web. We

would like to thank you for your time and look forward to meeting and working with you.

Cerritos Community College District Procedure No. 3720

General Institution

AP 3720 COMPUTER AND NETWORK USE

References: 2

Education Code, Section 72400; 3

Government Code, Section 3543.1(b); 4

Penal Code, Section 502; 5

17 U.S.C., Sections 101 et seq.; 6

Cal. Constitution Article 1, Section 1; 7

Federal Rules of Civil Procedure, Rules 16, 26, 33, 34, 37, and 45 8

PREAMBLE 9

These standards and administrative procedures defining and governing acceptable and 10

unacceptable use will apply to anyone who uses any computer system, network system, 11

Internet connectivity or intranet site or other data processing resources provided by the 12

District. It is considered a violation of District policy to use the District’s network and/or 13

Internet access in such a way that it interferes with or is incompatible with the user’s 14

performance, duties, or responsibilities. 15

As a condition for receiving and exercising computing privileges, a user of District 16

computing systems must read, understand, and comply with the standards and 17

procedures outlined herein and to any further guidelines provided by the administrators 18

of each area and/or system. 19

Unacceptable use is prohibited and can become grounds for loss of computing 20

privileges, disciplinary action up to and including termination or expulsion and/or legal 21

actions under local, state and federal laws. 22

The District is committed to providing access to computing resources to all members of

its current student body, faculty, staff and members of the Board of Trustees and other 24

authorized community members. While the fullest possible open access to District 25

computing facilities and systems is consistent with the educational and service missions 26

of the District, such access to this valuable and vulnerable District resource is a 27

privilege. The District is responsible for securing its network and computing systems to 28

a reasonable degree against failure, loss of data, and unauthorized access, while 29

making them accessible to the largest possible group of authorized and legitimate users 30

and uses within the financial and educational constraints of the District. 31

PRIVILEGES 32

An individual user must respect the rights of other users, respect the integrity of the 33

systems he/she is using, and observe all relevant laws and regulations. 34

Users do not own either District computers or accounts, but rather are granted the use 35

of such computers and accounts. The District owns the computers and accounts and 36

grants individuals the privilege of using them. 37

District employees may apply for user IDs to utilize email and restricted Internet

services. Connectivity to the Internet from off-campus locations is not provided for by 39

the District. 40

RESPONSIBILITIES 41

Each user is held accountable for his/her actions while using District resources. By 42

using his/her District provided resources, each user acknowledges and agrees to abide 43

by and conform to the following: 44

 Computers and networks are provided to support District related research, 45

instruction, learning, communication, distribution of scholarly information, and 46

administrative activities. 47

 A user shall not attempt to modify any system or network or attempt to crash or 48

“hack” into District systems. A user shall not tamper with any software protections or 49

restrictions placed on computer applications or files to protect shared assets, assets 50

managed by others, or software or data not part of a learning or research program in 51

approved curriculum. Unless properly authorized, a user shall not attempt to access 52

restricted portions of any operating system or security software. Improperly 53

accessing or attempting to access confidential information concerning students or 54

employees is prohibited. A user shall not attempt to remove existing software or add 55

his/her personal software to District computers and systems unless authorized by 56

the Director of Information Technology or his/her designee. 57

 Prior to the purchase and installation of new software or hardware, the authorizing 58

Dean/area manager should contact the Information Technology Department to verify 59

licensing restrictions and compatibility of new software with the computer(s) and the 60

network. 61

 An authorizing Dean/area manager must also contact the Information Technology 62

Department to verify software accessibility for students with disabilities prior to the 63

purchase and installation of any new software or hardware for educational programs. 64

 A user shall use only his/her designated computer account. An account is non-65

transferable: a user shall not use another individual’s ID, password or account. A 66

user should respect the privacy and personal rights of others and not access or copy 67

another user’s email, data or files without permission. A user is responsible for 68

his/her own computer account(s) and shall not allow others to use his/her 69

account(s). A user should take precautions, such as locking the computer on which 70

he/she is working when he/she is not able to physically control access, so that 71

others may not access his/her computer resources. A user should select a secure 72

password, one that cannot be found within the dictionary, or easily guessed. The 73

use of upper/lower case letters in conjunction with numbers in selecting a password 74

is highly recommended. 75

 A user is responsible for using software and electronic materials in accordance with 76

policies and the law expressly prohibit the copying of software in violation of their 78

copyrights. 79

INDIVIDUAL USER RIGHTS 80

An authorized user is entitled to due process rights as described in Board Policies, 81

Administrative Procedures and collective bargaining agreements. 82

The District will respect the exercise of academic freedom as described in Board Policy 83

and an individual user’s right to free speech provided that the exercise of such right 84

does not violate any existing District Board Policy, Administrative Procedure, local, state 85

or federal laws. Individual rights to free speech do not overrule or preclude the express 86

prohibition of harassment of individuals on or off campus. 87

The District and its authorized users shall respect individual ownership rights to 88

intellectual property, subject to existing District Board Policies, Administrative 89

Procedures and collective bargaining agreements. 90

Virtually no online activities or services guarantee absolute privacy. It is impossible for 91

the District to protect the privacy of email messages and other electronic files or 92

documents. A user should be aware that electronic mail, documents and files are not 93

entirely private and are more analogous to an open postcard than to a letter inside a 94

sealed envelope traveling through the U.S. mail. A user should exercise appropriate 95

care and caution. 96

The District cannot protect an individual against the receipt of material that may be 97

offensive to him/her. A user of District electronic computing is warned that he/she may 98

receive material that is offensive. Likewise, an individual who uses email or those who 99

place personal information on the Internet should know that the District cannot protect 100

an individual from an invasion of privacy. The District will make every reasonable 101

attempt to honor the privacy of an individual using the District’s computing resources 102

for District business within the guidelines of the Electronic Communications Privacy Act 103

(ECPA), which makes it illegal to intercept electronic communications on a public or 104

private network without proper authorization, and state and federal students records 105

laws including the Family Educational Rights and Privacy Act (FERPA), and the Health 106

Insurance Portability and Accountability Act (HIPAA). 107

The District reserves the right, for an extraordinary reason (e.g., basic system security, 108

the safety of the campus or of an individual member of the campus community, the 109

interception of suspected illegal or inappropriate activity), to access and monitor all files, 110

and Internet and email use. 111

APPROPRIATE USES OF DISTRICT COMPUTER RESOURCES 112

The District’s computing facilities and network systems are provided to support the 113

instructional, cultural, research, professional and administrative activities of the District. 114

An employee may use District computers and the network for union activities in 115

accordance with applicable collective bargaining agreements and policies and 116

procedures governing the use of District equipment. A user is required to behave in a 117

responsible, ethical and legal manner and to follow this procedure and existing Board 118

Policies, Administrative Procedures and local, state and federal laws. 119

Individual divisions or areas within the District may define additional conditions of use 120

for information resources under their control. These statements must be consistent with 121

this overall procedure but may provide additional detail, guidelines and/or restrictions. 122

PROHIBITED USES OF COLLEGE COMPUTER RESOURCES 123

A user may not participate in any activities knowingly and/or carelessly that have the 125

potential to interfere with or disrupt network users, services, or equipment. The 126

distribution or “forwarding” of spam or unsolicited advertising is strictly prohibited. The 127

District equipment may not be used to violate copyright laws or license agreements. No 128

one may inspect, change, copy or distribute proprietary data, programs, files, disks or 129

software without the proper authority. The prohibited transmission of copyrighted 130

material is forbidden without the express written authorization of the copyright holder. 131

Computer software protected by copyright must not be copied into, away from, or with 132

the use of campus computing facilities, except as permitted by law or by the terms of 133

the copyright. This means that such computer software may only be copied in order to 134

make back-up copies. The number of copies and distribution of copies may not be 135

done in such a way that the number of simultaneous users in a department exceeds the 136

number of original copies purchased by that department unless concurrent licensing 137

applies. 138

Defamation/Libel/Slander 139

Creating or transmitting any false statement that causes injury to an individual’s 140

reputation is strictly prohibited. Any user creating or transmitting defamatory statements 141

shall have sole liability for any damages resulting from such defamatory statement. Any 142

user may also be subject to the District disciplinary procedures for such action. 143

The user agrees never to attempt to transmit, or cause to be transmitted, any message 144

in which the origination is deliberately misleading. 145

Commercial and Political Use 146

Commercial use of the District computing systems for personal gain is prohibited. Use 147

for commercial and illegal purposes is unacceptable (e.g. inappropriate mass mailing or 148

“spamming”). This is in direct violation of the Cenic policy under which the District 149

obtains its access to the Internet. (See section 10 of the procedure.) 150

Personal use may be restricted if the resources consumed interfere with equitable 151

access by other users and the utilization of the system for school business purposes. 152

Direct marketing of personal products and services of any kind is prohibited. 153

Transmitting any unsolicited advertising, promotional materials or other forms of 154

soliciting is prohibited without authorization from District administration. 155

Links to external sites that market required or recommended instructional materials are 156

allowed only if such links appear in the context of other required and recommended 157

instructional materials, more than one source for such materials is listed, and the 158

materials are available at the campus bookstore and shelved with instructional items. 159

References on individual web pages to external sites that market non-instructional 160

products and services such as consulting services, etc. are allowed only in the context 161

of a résumé listing. 162

Links to external sites using direct marketing language such as “consulting services” is 163

not permitted. 164

The District is a non-profit, tax-exempt organization and, as such, is subject to specific 165

local, state and federal laws regarding sources of income, political activities, use of 166

property and similar matters. District information resources must not be used for 167

partisan political activities that urge the support or defeat of any ballot measure or 168

candidate, or where such use would otherwise be prohibited by local, state, or federal 169

laws, Board Policy or Administrative Procedures. 170

Use of District Computing System and Resources

171

Creating, accessing, transmitting, uploading, downloading, printing, or storing sexually

172

explicit, obscene, pornographic, indecent, or lewd material or messages is prohibited, 173

except to the extent that such actions are in furtherance of research or a project that is 174

reasonably and legitimately related to an employee’s position or a student’s coursework. 175

Processing, transmitting, downloading, or publishing any material in violation of any

176

local, state or federal law is prohibited, including but not limited to the following: 177

1. Creating, accessing, transmitting, uploading, downloading, printing, or178

storing sexually explicit, obscene, pornographic, indecent, or lewd material or179

messages, except to the extent that such actions are in furtherance of research 180

or a project that is reasonably and legitimately related to an employee's position 181

or student's coursework. 182

2. Creating, accessing, or transmitting material or messages that could be 183

considered discriminatory, offensive, threatening, harassing, intimidating, vulgar, 184

profane, or violent. 185

3. Creating, accessing, or transmitting material or messages that could be 186

considered defamatory. 187

4. Violating any state or federal statute or District policy or regulation. 188

5. Creating, forwarding, or exchanging spam, chain letters, mass postings, 189

solicitations, or advertising. 190

6. Using District computers, networks, or Internet access for partisan political 191

activities that urge the support or defeat of any ballot measure or candidate, or 192

where such use would otherwise be prohibited by local, state or federal laws, 193

Board Policy or Administrative Procedures. 194

7. Unauthorized use, duplication, or transmission of copyrighted material or other 195

intellectual property (including software license agreements). 196

8. Accessing or communicating another individual's password, personal 197

identification number, or other information or files without permission. 198

9. Using District computers, networks, or Internet access for illegal or unethical 199

activities or unauthorized purposes. 200

10. Using District computers, networks, or Internet access for private or personal 201

financial gain, or in connection with non-District consulting, business, or 202

employment. 203

11. Gaining, attempting to gain, or instructing others as to how to gain unauthorized 204

access to District computers, networks, or Internet access. 205

12. Obscuring or instructing others as to how to obscure the true identity of a user. 206

13. Attempting to modify, reconfigure, add, or remove computer equipment, software, 207

hardware, or peripherals without proper authorization. 208

14. Downloading software onto District computers, hardware, or equipment, or 209

through the District network or Internet connectivity without proper authorization. 210

15. Vandalizing, damaging, disabling, or destroying District property or the property 211

of another individual or organization. 212

16. Knowingly engaging in any activity harmful to the District's computers, networks, 213

or Internet access, or to the security or integrity of such systems. 214

17. Creating, installing, or propagating a computer virus, worm, or other 215

surreptitiously destructive program on any District computer, network, or via 216

District Internet access, regardless of whether any demonstrable harm results. 217

18. Circumventing or subverting any District computer, network, or Internet security 218

measures or logon procedures. 219

19. Violating any software license or copyright, including copying, redistributing, 220

storing, or transmitting copyrighted software without the written authorization of 221

the software owner. 222

20. Sending any fraudulent electronic communication. 223

21. Willfully interfering with another's authorized computer, network, or 224

Internet usage. 225

22. Connecting any computer, hardware, or equipment to the District's network, 226

Internet connection, or peripherals without authorization and/or without 227

confirmation that the computer/hardware/equipment meets the technical and 228

security standards set by the District. 229

23. Unauthorized distribution of District data and/or proprietary information. 230

24. Performing any activity that could cause the loss or corruption of, or prevent 231

rightful access to District data or information, or which will interfere with the 232

normal operation of computer, networks, Internet connectivity, or other 233

resources. 234

25. Creating, accessing, or participating in online gambling. 235

26. Non-work related or coursework-related uses such as playing games or 236

participating in dating services. 237

27. Uses in the furtherance of academic dishonesty. 238

28. Forging, fraudulently altering or falsifying, or otherwise misusing District records 239

or documents. 240

Viruses and “Hacking” 241

A user may not upload, transmit, intentionally download, or participate in any manner in 242

the creation, promulgation, publication or use of computer viruses on District resources 243

not designated for such research purposes. A user may not knowingly or carelessly 244

introduce or distribute (i.e. by “forwarding”) any invasive or destructive programs (such 245

as viruses, worms, Trojan Horses) in the District computing system. 246

Engaging in any form of “hacking” (i.e. gaining illegal access) while using the District 247

computing or network systems is prohibited. “Hacking” includes, but is not limited to, 248

gaining access to restricted computer systems/sites and/or viewing, copying, 249

downloading or altering the computer programs, data files, and other materials 250

contained therein. 251

Improper Use of Private Passwords and Security Devices 252

A user shall use only his/her designated computer account(s) or an appropriate 253

authorized “generic” account to which he/she is entitled to access. A user is 254

responsible for his/her computer account(s) and shall not allow others to use his/her 255

computer account(s). Individual password security is the responsibility of each user. A 256

user may not use any passwords, recognition codes, security access information, or 257

physical locking devices such as locks on any part of the computing system without the 258

District’s prior written consent. A user must inform the Director of Information 259

Technology in writing all electronic security devices the user wishes to use prior to using 260

them and provide electronic keys, passwords, access codes and/or other security 261

information or materials to permit the District to obtain access to the user’s secured 262

areas. The District reserves the right to remove any such device at any time at the 263

District’s discretion. 264

Users should always maintain their own backups of their protected data as the removal 265

of any private protection systems, of which the District was not aware, could result in 266

unrecoverable data loss. It is a violation for users to protect any assets to which the 267

District has an interest with such systems if the keys are not placed in a proper, 268

authorized escrow with the Director of Information Technology. 269

System Alterations 270

Modifying or altering the computing system (except in approved research or for 271

instructional purposes) in any way is prohibited. This includes but is not limited to 272

altering or attempting to alter system software or hardware configurations on either 273

network systems or local computing devices; installing unauthorized software programs 274

on District local computing devices or network systems and/or using such programs; 275

and/or attempting to circumvent local or network system security measures. 276

Modification and alteration of the computing system does not include ordinary 277

operations involving the saving and deleting user generated files that are created in 278

furtherance of District business or educational purposes. 279

Nondiscrimination/Discriminatory Harassment 280

A user has the right to be free from any conduct connected with the use of the District’s 281

computer and network resources which discriminates against any person on the basis 282

of the categories contained in BP 3410 titled Nondiscrimination. Using the District 283

computer and network resources to transmit any message, create any kind of 284

communication, or store information which violates District policies or procedures 285

regarding discrimination or harassment is prohibited. 286

Unauthorized Use/Failure to Follow Procedures 287

Use of the computer and network systems is a privilege extended to students and 288

employees and not a right. An employee user will provide acknowledgement of receipt 289

of the terms and conditions in Administrative Procedure 3720 to the District before the 290

District will provide use privileges. The written acknowledgement will be retained in the 291

employee’s personnel file. A student user will be provided notice of the terms and 292

conditions of this Administrative Procedure through the class schedules, the District 293

website and applicable instructional materials. 294

If substantial amendments, modifications and/or a revocation of the terms and

295

conditions of this Administrative Procedure are made, an employee user will be required 296

to provide a written acknowledgement of receipt of notice of these changes to the 297

Human Resources Office within a reasonable period of time, not to exceed 60 days. 298

Failure to comply with this requirement may result in restriction from computer privileges 299

until the District has received the written acknowledgement. A student user will be 300

notified through the class schedule, the District website and applicable instructional 301

materials. 302

Each employee or student user is responsible for his/her authorized use of the 303

computers and network as described in this Administrative Procedure. Unauthorized 304

use of the computer and/or network system includes: 305

 Failure to follow the procedures set forth in this procedure and/or306

 Engaging in the activities described in Section 6, Prohibited Uses of District307

Computer Resources, of this procedure and/or308

 Use of the computer and/or network system in a manner which violates local,309

state, or federal laws, Board Policy, Administrative Procedures or reasonable310

rules and regulations of the District or a department and/or311

 Use of the computing and/or network system in a manner which damages or312

harms any person and/or the property of the District.313

An employee user who engages in unauthorized or prohibited use of the computer 314

and/or network system may lose computer privileges and/or may be subject to 315

disciplinary action up to and including termination from employment. A student user 316

who engages in unauthorized or prohibited use of the computer and/or network system 317

may lose computer privileges and/or may be subject to disciplinary action up to and 318

including suspension or expulsion. 319

If allegations of unauthorized or prohibited use are made against a user and the District 320

pursues disciplinary action, disciplinary procedures in this action will follow the 321

applicable Education Code sections and Board Policies. 322

If a user engages in unauthorized or prohibited use which constitutes a violation of local, 323

state, or federal laws, such violation will be reported to the appropriate law enforcement 324

agency for prosecution as deemed appropriate by the law enforcement or regulatory 325

agency. 326

Additional Guidelines

327

The District retains the right to revoke, amend, or change the provisions of this 328

Administrative Procedure for Computer and Network Use. However, any such changes 329

to these procedures will first be reviewed by the Information Technology Standards 330

Committee and the college community shall be informed of such changes through 331

email. 332

Any defects discovered in computing and network system accounting or system security 333

must be reported promptly to the Director of Information Technology so that steps can 334

be taken to investigate and solve the problem. 335

Disclosure

336

A user should be aware that he/she does not have an expectation of privacy in the use 337

of District computing and network resources. The District reserves the right to monitor 338

all use of District computer and network system to assure compliance with these 339

procedures. The District will only exercise this right for legitimate District purposes, 340

including but not limited to ensuring compliance with this procedure and the integrity 341

and security of the computing system. 342

A user is advised that there is the possibility of unintended disclosure of

343

communications. A user is advised that it is possible to retrieve information entered on 344

or transmitted via computer and communication systems, even if a user deletes such 345

information. 346

The California Public Records Act (Government Code, Sections 6250 et seq.) includes 347

computer transmissions in the definition of “public records” and communications made 348

on the District network or computing system which is not defined by law as exempt must 349

be disclosed if requested by a member of the public. 350

Computer transmissions and electronically stored information may be discoverable in 351

litigation. 352

“Cenic” Policy

353

Cenic is the District’s Internet Service Provider (ISP). District faculty, staff and students 354

are users of the services provided by Cenic and, therefore, must agree to abide by all 355

policies established by Cenic for the use of its network. The latest revision of the Cenic 356

policy is available for viewing at www.cenic.org which may be accessed by using the 357

“Network” tab and selecting “Policies.” This Cenic policy is available as a reference for 358

faculty, staff and students to review. 359

Offices of Primary Responsibility: Vice President, Business Services 360

Human Resources 361

Date Approved: November 26, 2007

(Replaces former Cerritos College Policy 3032

(4400))

PERSONAL SAFETY

CAMPUS

Cerritos

College

Annual Security Report - 2016

Page 1 of 15

THE ANNUAL SECURITY REPORT

The Campus Police Department prepares this report to comply with the Jeanne Clery Disclosure of Campus

Security Policy and Crime Statistics Act. The full text of this report can be located on our website at

www.cerritos.edu/securityreport.

Copies of this report may also be obtained at the Campus Police Station located

on the south side of campus at 11090 New Falcon Way, Cerritos CA or by calling (562) 924-3618. Notification of

the availability of this report is provided to students and potential students in the Class Schedule each semester.

Students are also notified via email of the availability of this report by October 1

of each year. Faculty and staff

receive similar notification via interoffice mail by October 1

of each year.

ABOUT THE

CERRITOS

COLLEGE POLICE DEPARTMENT

The Board of Trustees has established the Cerritos College Police Department (CCPD), which has primary

responsibility for patrolling district property. The Police Department’s jurisdiction includes other grounds or

properties owned, operated, controlled, or administered on behalf of the Cerritos Community College District as

outlined in the Education Code, Section 72330. CCPD is committed to the safety and security of all students, staff,

and faculty, as well as others visiting Cerritos College. CCPD is responsible for patrolling district grounds, facilities,

and parking lots to protect persons and property and enforce applicable laws and ordinances.

CCPD police officers have complete police authority to apprehend and arrest anyone involved in illegal acts,

pursuant to California Penal Code Section 830.32 and Education Code Section 72330. Having met all state

standards for selection and training, the officers have authority equal to a municipal police officer or county deputy

sheriff.

CCPD personnel work closely with local, state, and federal police agencies and have direct radio communication

with the Los Angeles County Sheriff’s Department as well as other local, state, federal, and military agencies which

participate in the Los Angeles Regional Tactical Communication System (LARTCS). CCPD is also part of the State

of California 911

Emergency

System.

In addition to police officers, CCPD employs police cadets who patrol the campus on foot,cart and by bicycle.

hile

not police officers, cadets each have radio contact with CCPD and can summon assistance when necessary.

Cerritos College has a formal “Memorandum of Understanding” (MOU) with the Los Angeles County Sheriff’s

Department for its assistance with incidents that require resources not available on-site. This agreement also

clarifies operational responsibilities for investigations of Part 1 violent crimes and delineates the specific

geographical boundaries of each agency’s operational responsibility. This written agreement is public record and is

made available for inspection by members of the public upon request to the Chief of the Cerritos College Police

Department. Resources from other local, state and federal agencies are also available for incidents requiring

special personnel or equipment.

REPORTING

CRIMINAL ACTIVITY

Members of the district, guests and the general public are strongly encouraged to

immediately

report all crimes and

public safety related incidents to the Campus Police Department (AP §3515). Crimes should be reported,

regardless of the victim’s desire for prosecution, to ensure inclusion in the annual crime statistics and to aid in

providing timely safety warnings to the community, when appropriate.

The Cerritos College Police Department is staffed 24 hours a day, 7 days a week. A person may report any

criminal activity, suspected criminal activity, or any other emergency by calling the police department. The

police department can be reached by calling (562) 860-2451, ext. 2325 for routine inquiries, or in case of

emergency, by dialing 911 from any campus extension or pay phone on campus. There are also Emergency

Phones located throughout the campus which directly dial the police department. Emergency calls can also be

made via cell phone by dialing (562) 402-3674. Reports may be made in person at the police department, which is

located on the south side of campus at the 11090 New Falcon

ay, Cerritos CA 90703.

All CCPD incident reports will be investigated and those with sufficient information to warrant

Page 2 of 15

criminal filing will be submitted to the District Attorney’s office for consideration. Reports involving students in

violations of the law or the Student Standards of Conduct are forwarded to the Office of Student Conduct and

Grievance for review and potential action.

MISSING PERSON REPORT

The Cerritos College Police Department does not consider any report of a missing person to be routine and assumes

that the missing person is in need of immediate assistance until the facts reveal otherwise. The Cerritos College

Police Department gives missing person cases priority over property related cases and will not require any time frame

to pass before beginning a missing person investigation. (Penal Code 14205)

DAILY CRIME LOG

The Cerritos College Police Department maintains a daily crime log which is a record of all crimes reported to the

police department which have occurred either on campus property, non-campus building/property or public property

immediately adjacent to campus. The log reflects the time and date the crime was reported to the police department,

the location and nature of the reported incident, along with a case disposition. The police department may withhold

information from the daily crime log if the release of such information would jeopardize an ongoing criminal

investigation, the safety of an individual, cause a suspect to evade detection or flee, and/or result in the destruction of

evidence. The police department’s crime log is open for public inspection in the front lobby at anytime.

OFF-CAMPUS CRIMINAL ACTIVITY

Cerritos College does not have off-campus student organizations. Crimes which occur at off-campus district

approved events, such as athletic competitions, should be reported to the law enforcement agency with

jurisdiction over the area the crime takes place.

CONFIDENTIAL REPORTING

If you are the victim of a crime but do not want to pursue action within the criminal justice or college system, you

may still want to consider making a confidential report.

ith your permission, the Vice-President of Human

Resources or a designee of can file a report on the details of the incident without revealing your identity. The

purpose of a confidential report is to comply with your wish to keep the matter confidential, while taking steps to

ensure the future safety of yourself and others. With such information, the college can keep an accurate record of

the number of incidents on campus, determine where there is a pattern of crime with regard to a particular location,

method or assailant, and alert the campus community to potential danger. Reports filed in this manner are counted

and disclosed in the annual crimes statistics for the institution.

On-campus counselors and mental health professionals are encouraged to inform persons they are counseling of

the procedures to report crimes on a voluntary, confidential basis for inclusion in the annual crime statistics.

DISCLOSURES

TO ALLEGED VICTIMS OF CRIMES OF

VIOLENCE

NON-FORCIBLE

SEX OFFENSES

Cerritos College will, upon written request, disclose to the alleged victim of a crime of violence, or a non-forcible sex

offense, the results of any disciplinary hearing conducted by the college against the student who is the

alleged perpetrator of the crime or offence. If the alleged victim is deceased as a result of the crime or offence, the

college will provide the results of the

disciplinary

hearing to the victim’s next of kin, if so requested. The request will

be made through the Office of Student Conduct and Grievance.

TIMELY SAFETY WARNINGS

The District publishes “timely safety warnings” to the campus community any time a situation arises, either on or off

campus that, in the judgment of the President/Superintendent or designee, represents an ongoing or continuing

threat to students and employees. These warnings are disseminated by the Campus Police Department in a timely

manner, without delay, so as to aid in the prevention of similar crimes. (See Administrative Procedure 3515.)

Page 3 of 15

Warnings will be issued through the college e-mail system to students, faculty, staff and the campus’ student

newspaper “Talon Marks”.

In the event of circumstances that could pose an immediate threat to the community and individuals, the Campus

Police Department may also alert the community via text messaging utilizing Nixle, as well as posting a notice

on the electronic bulletin board accessible at

www.cerritoscollege.us.

Copies of the notice are also posted

throughout campus.

Anyone with information warranting a timely safety warning should report the circumstances to the Campus Police

Department, by phone at (562) 924-3618 or in person at the Campus Police Station located on the south side of

campus at 11090 New Falcon

ay, Cerritos CA 90703.

CRIME PREVENTION AND AWARENESS

Cerritos College enjoys a crime rate much lower than that of the surrounding area, but, in today’s society, no

community can be totally risk-free. The Campus Police Department recognizes that safety on campus is everyone’s

concern. Campus Police partners with students, staff and faculty in creating an atmosphere that is safe and

encourages learning. Working together with student government, staff and f aculty groups and various clubs on

campus, the police department strives to provide education while identifying specific concerns of the campus

community.

Page 4 of 15

EDUCATION

Periodically

throughout the year, CCPD officers, in cooperation with other campus departments and student clubs,

present crime prevention awareness sessions on sexual assault, theft, vandalism, and personal safety.

CCPD has participated in numerous Campus Safety Forums which provided an overview of campus safety resources

and emergency protocols for students and staff, installed several Blue Emergency Phones in high traffic areas of

campus and began a comprehensive safety initiative to install security cameras in multiple buildings across campus.

The district hired a Director of Diversity, Compliance, and Title IX Coordinator who will continue to improve our

reporting process for incidences of Sexual Assault, Sexual Harassment, Stalking, and Dating and Domestic Violence.

The CCPD, in concert with the Student Health and Wellness Clinic, established the Falcon Safe training initiative,

holding a dozen presentations for students regarding affirmative consent, bystander intervention, and Sexual

Violence Prevention. They also created a partnership with the Women’s Studies Program to offer events, panels, and

workshops with a focus on violence prevention, including but not limited to Rape Aggressive Defensive (RAD)

training, a nationwide self-defense class for women. CCPD also coordinated a series of campus wide events to

celebrate the national Campus Safety Awareness month.

In the last year, CCPD has provided almost a dozen training sessions on Emergency Preparedness and Disaster

Response to the campus community. CCPD assisted in c o n d u c t i n g a campus wide e v a c u a t i o n drill.

Efforts to educate the community will continue, along with expanded,

multi-agency

drills.

The Campus Police Department has made focused efforts to educate and inform the campus community about its

number one crime problem, w h i c h i s the theft of unattended property. By using various media outlets on

campus, the police department has increased awareness and solicited the help of campus members in protecting

personal property.

Our theme remains that all awareness and crime prevention programs are to encourage students and employees

to be aware of their

responsibility for their

own security and the security of others.

In addition to seminars, information is disseminated to students and employees through crime prevention

awareness fliers, security alerts, and articles in the campus and student newspapers.

PREVENTION

In addition to routine vehicle patrol, campus police officers and police cadets participate in bicycle patrols and

foot patrols, allowing better

accessibility

by students as well as more effective patrol of inner portions of the campus.

Crime prevention programs on personal safety and theft prevention are sponsored by various campus

organizations throughout the year. CCPD personnel facilitate programs for students, faculty and new employees

providing a variety of educational strategies and tips on how to protect themselves from sexual assault, theft and

other crimes.

At least once a year, the police department and members of the student government team up for a “safety walk” of

the campus. These safety walks supplement ongoing efforts to evaluate areas such as lighting, landscaping,

building access, and

emergency

phones to best increase security.

The department provides an escort service 24 hours a day, 7 days a week. In addition, personnel are available to

assist with dead car batteries or keys locked in cars.

SAFETY TIPS

•

Stay alert and be aware of your surroundings. Know what is typical and what is not.

•

Report all crimes and suspicious activity to Campus Police immediately.

•

Avoid walking alone after dark. Make

arrangements

to travel with friends along a well-lit route, or request

Page 5 of 15

an escort from Campus Police.

•

Most crimes on campus are thefts of unattended property. Do not leave purses, backpacks, books, etc.

unattended, even for a minute.

•

Know the location of

Emergency

Phones and Pay Phones in the areas you frequent.

•

Never leave valuables visible from outside your vehicle. Lock all property including books, purses and

backpacks in your trunk or take them with you.

•

Lock your office door if working after hours

•

Let others know where you are going,

especially

if you might be there alone.

•

If you are

uncomfortable,

go to where there are other people.

•

Headphones can eliminate your ability to be aware of your surroundings.

•

Move

confidently

at a steady pace and make eye contact with people.

Page 6 of 15

•

Keep keys in hand when walking to a vehicle.

•

Keep windows and doors locked.

•

Check the interior of a vehicle before getting in.

•

Go to the nearest open business or police station if you are being followed.

SAFETY POLICIES

The Cerritos College Board of Trustees has adopted numerous policies addressing safety issues on campus. Some

of these include:

SECURITY OF AND ACCESS TO FACILITIES

During business hours, the District will be open to students, employees, contractors, and

community

members.

During non-business hours, access to all District facilities is by key, if issued, or by admittance via the Campus

Police

Department.

In the case of periods of extended closing, the District will admit only those with prior written

approval to all facilities. Cerritos College does not have student housing.

Some facilities may have individual hours, which may vary at different times of the year. In these cases, the

facilities will be secured according to schedules developed by the department responsible for the facility.

Emergencies

may necessitate changes or alterations to any posted schedules. Areas that are revealed as

problematic will have regular periodic

security

surveys. The Vice Presidents of Student Services and Business

Services, and managers from the Campus Police

Department,

Facilities Department, and other concerned areas

review these results. These surveys examine security issues such as landscaping, locks, alarms, lighting, and

communications.

Additionally, the Director of Physical Plant and Construction Services, and the Chief of Campus

Police, co-chair the District Committee on Safety which consists of

representatives

from the various constituencies

on campus and meets on a monthly basis to discuss issues of pressing concern. (AP §3501)

WEAPONS

Firearms, knives, explosives, or other dangerous objects, including but not limited to any facsimile firearm, knife, or

explosive, are prohibited on all District grounds, except as authorized by law.

ALCOHOL AND ILLEGAL DRUG

POSSESSION,

USE AND SALE

The possession, sale or the furnishing of alcohol on campus is governed by California state law and these

procedures. The possession, sale, consumption or furnishing of alcohol is controlled by the California Department

of Alcohol and Beverage Control. However, the

enforcement

of alcohol laws on-campus is the

primary

responsibility

of the Campus Police Department. The campus has been designated “Drug free” and only under certain

circumstances is the consumption of alcohol permitted. The possession, sale, manufacture or distribution of any

controlled substance is illegal under both state and federal laws. Such laws are strictly enforced by the Campus

Police Department. Violators are subject to disciplinary action, criminal prosecution, fine and/or imprisonment. It

is unlawful to sell, furnish or provide alcohol to a person under the age of 21. The possession of alcohol by

anyone less than 21 years of age in a public place or a place open to the public is illegal. It is also a violation of

this policy for anyone to consume or possess alcohol in any public or private area of campus without prior District

approval.

Organizations

or groups violating alcohol or substance policies or laws may be subject to sanctions by the

District.

Alcoholic beverages on campus are permitted if:

•

The alcoholic beverage is for use in connection with a course of instruction, sponsored dinner or meal

demonstration given as part of a culinary arts program, and the instructor or individual has been authorized

to acquire, possess, use, sell, or consume it by the President/Superintendent;

•

The alcoholic beverage is possessed, consumed or sold during a special event, which is sponsored by the

Cerritos College Foundation and authorized by the President/Superintendent, where the principal

attendees are members of the general public or invited guests and not students.

Page 7 of 15

DRUG AND ALCOHOL FREE ENVIRONMENT AND DRUG AND ALCOHOL ABUSE PREVENTION

PROGRAM

The District is committed to providing its employees and students with an alcohol and drug-free

campus and workplace environment. It emphasizes prevention and intervention through education.

PREVENTION AND INTERVENTION PROGRAMS

The District provides education and maintains programs and services designed to aid students,

employees and their families in receiving assistance for alcohol and/or drug abuse problems. Included

in these educational and assistive programs and services are:

•

Notification of the dangers of drug use and

dependency

in the class schedule;

•

Mental health services provided to students through the Student Health Services; and

•

An Employee Assistance Program (EAP) for employees and their families:

ALCOHOL AND DRUG PROHIBITIONS

The unlawful manufacture, distribution, dispensing, possession, or use of alcohol or any controlled

substance is prohibited on District property, during District-sponsored field trips, activities or

workshops, and in any facility or vehicle operated by the District.

Violation of Board Policy 3550, Drug and Alcohol Free Environment and Drug and Alcohol Abuse

Prevention Program, will be addressed by the District. The District will take appropriate action

designed to address each specific violation, which may include, but is not limited to:

•

Termination of employment,

•

Expulsion,

•

Referral to Campus Police or other law

enforcement

agency for prosecution as permitted by law

•

Mandatory

participation in an alcohol or drug abuse assistance or rehabilitation program

The Campus Police Department vigorously enforces Federal and State underage drinking laws as well

as Federal and State drug laws.

EMERGENCY

RESPONSE AND

EVACUATION

ROCEDURES

General information about the emergency response and evacuation procedures for the District is

publicized each

year as part of the District’s Clery Act compliance efforts and that information is

available at www.cerritoscollege.us.

All members of the campus community are notified on an annual basis that they are required to notify

the Campus Police Department of any incident on campus that involves a significant emergency or

dangerous situation that may involve an immediate or ongoing threat to the health and safety of

students and employees on campus. The Campus Police Department has the responsibility of

responding to, and summoning the necessary resources, to mitigate, investigate, and document any

situation that may cause a significant emergency or dangerous situation. In addition, Campus Police

has a responsibility to respond to such incidents to determine if the situation does in fact, pose a threat

to the community. If so, federal law requires that the institution immediately notify the campus

community

or the

appropriate

segments of the

community

that may be affected by the situation.

Upon confirmation or verification by the District that a legitimate emergency or dangerous situation

involving an immediate threat to the health or safety of students or employee occurring on campus,

the District will determine the content of the message and will use some or all of the systems

described below to communicate the threat to the campus community or to the appropriate segment

of the community, if the threat is limited to a particular building or segment of the population. The

District will, without delay, take into account the safety of the community, determine the content of the

Page 8 of 15

notification and initiate the notification system, unless issuing a notification will, in the judgment of the

first responders (including, but not limited to Campus Police), compromise the efforts to assist a victim

or to contain, respond to, or otherwise mitigate the emergency.

In the event of a serious incident that poses an immediate threat to members of the campus community,

the District has various systems in place for communicating information quickly. Some or all of these

methods of communication may be activated in the event of an immediate threat to the campus

community. These methods of communication include network emails, emergency text messages that

can be sent to a phone or Personal Digital Assistant (individuals can sign up for this service on the

District website), public address system, District website and emergency messages that scroll across

display screens in campus buildings. The District will post updates during a critical incident on the

District website at www.cerritos.edu. Individuals can call the District’s recorded information telephone

line at (562) 860-2451 for updates. Cerritos College students, staff, faculty and others can sign up

for emergency text message alerts at

www.cerritoscollege.us

or text keyword "CCALERTS" to 888777

from their mobile phones.

The District’s Director of Public & Governmental Relations will be responsible for the dissemination of

emergency information to the larger

community

through media alerts.

TESTING EMERGENCY RESPONSE AND EVACUATION PROCEDURES

An evacuation drill is coordinated by the Campus Police Department at least once per year for all

facilities on campus. Students learn the locations of the emergency exits in the buildings and are

provided guidance about the direction they should travel when exiting each facility for a short-term

building evacuation.

Evacuation drills are monitored by the Campus Police Department and District administration to

evaluate egress and behavioral patterns. Reports are prepared by participating departments which

identify deficient equipment so that repairs can be made immediately. Recommendations for

improvements are also submitted to the appropriate departments and offices for consideration.

Campus Police and District administration coordinate announced and unannounced evacuation drills

at least once per year, as described above, to test the emergency response and evacuation

procedures, and to assess and evaluate the

emergency

evacuation p l ans a n d capabilities. For each

test conducted, Campus Police will document a description of the exercise, the date, time, and

whether it was announced or unannounced. The District will publish a summary of its emergency

response and evacuation procedures in conjunction with at least one drill or exercise each calendar

year.

In the event of an emergency, natural disaster or the occurrence of a hazardous condition the District

will activate its plan and procedures to protect and govern employees, students, visitors, and children

in childcare programs on campus and/or in district-owned or operated facilities. The District shall

maintain an emergency management team to aid in the creation, maintenance, updating, and

implementation

of its

emergency

plan and procedures.

SEXUAL ASSAULT PREVENTION AND RESPONSE

Any sexual assault or physical abuse, including, but not limited to, rape, domestic violence, dating

violence, sexual assault, or stalking, as defined by California law, whether committed by an employee,

student, or member of the public, occurring on District property, in connection with all the academic,

educational, extracurricular, athletic, and other programs of the District, whether those programs take

place in the District’s facilities or at another location, or on an off-campus site or facility maintained by the

District, or on grounds or facilities maintained by a student organization, or at a District-sponsored activity

on non-District property is a violation of District policies and regulations and is subject to all applicable

Page 9 of 15

punishment, including criminal procedures and employee or student discipline procedures. (Also see BP

5500 titled Standards of Conduct and AP 5520 titled Student Discipline Procedures.)

“Sexual assault” includes but is not limited to, rape, forced sodomy, forced oral copulation, rape by a

foreign object, sexual battery, or threat of sexual assault.

“Dating violence” means violence committed by a person who is or has been in a social relationship of a

romantic or intimate nature with the victim.

“Domestic violence” includes felony or misdemeanor crimes of violence committed by:

•

a current or former spouse of the victim;

•

by a person with whom the victim shares a child in common;

•

by a person who is cohabitating with or has cohabitated with the victim as a spouse;

•

by a person similarly situated to a spouse of the victim under California law; or

•

by any other person against an adult or youth victim who is protected from that person’s acts

by California law.

“Stalking” means engaging in a course of conduct directed at a specific person that would cause a

reasonable person to fear for his or her safety or the safety of others, or to suffer substantial emotional

distress.

The District has established a Crisis Assessment, Intervention and Response (CAIR) team on campus.

CAIR consists of representatives from Counseling, Student Health and Wellness Services, the Office of

Student Conduct and Grievance, Disabled Students Programs and Services, the Title IX Coordinator and

Campus Police. CAIR, with the assistance of outside experts in sex offense education, educates the

campus community about sexual assaults, domestic violence, dating violence and stalking through on-

campus training programs. Literature on these matters, risk reduction and District response is available

through Student Health and Wellness Services and Campus Police.

If you are a victim of a sexual assault on campus, your first priority should be to get to a place of safety.

You should then obtain necessary medical treatment. The Campus Police Department strongly

advocates that a victim of sexual assault report the incident in a timely manner. Time is a critical factor

for evidence collection and preservation. An assault should be reported directly to Campus Police.

Filing a police report with a CCPD officer will not obligate the victim to prosecute, nor will it subject the

victim to scrutiny or judgmental opinions from officers. Filing a police report will:

•

Ensure that a victim of a sexual assault receives the

necessary

medical treatment and tests, at

no expense to the victim

•

Provide the opportunity for collection of evidence helpful in prosecution, which cannot be

obtained later (ideally a victim of sexual assault should not wash, douche, use the toilet, or

change clothing prior to a

medical/legal

exam)

•

Assure the victim has access to free confidential counseling from counselors

specifically

trained

in the

ea of sexual assault crisis intervention

When a sexual assault is reported to Campus Police, Campus Police may, with the victim’s consent,

notify other personnel as necessary to provide care and services to the victim. These personnel include

the President/Superintendent; Vice President of Student Services, Dean of Student

Services/Coordinator of Student Conduct and Grievance, Director of Diversity, Benefits and Compliance;

and/or the

Associate Dean

of Student Health and Wellness Services.

A student who alleges being a victim of a sexual assault may choose for the investigation to be

pursued through the criminal justice system and the Office of the Title IX Coordinator, or only

Page 10 of 15

the latter. A representative from the Police Department or the Office of the T i t l e I X C o o r d i n a t o r

will guide the complainant through the available options and support the victim in his or her

decision. Various counseling options are available from the College through Student Health and

Wellness Services and/or the Employee Assistance Program. Counseling and support services outside

the District system are available by contacting the National Sexual Assault Hotline at (800) 656-HOPE

(1-800-656-4673).

District disciplinary proceedings are detailed in the Cerritos College General Catalog. Both the victim

and accused are entitled to the same opportunities to have others present during a disciplinary

proceeding. Both the victim and accused will be informed of the outcome of any hearing. A

student found guilty of violation o f the District sexual misconduct policy could be criminally prosecuted

in the state courts and may be suspended or expelled from the District for the first offense. Student

victims have the option to change their academic situation after an alleged sexual assault, if such

changes are

reasonably

available.

BYSTANDER INTERVENTION

Bystander intervention, in the context of this report, includes safe and positive options that may be carried out

by faculty, staff and students to prevent harm or intervene when there is a risk of sexual harassment, sexual

assault, dating violence, domestic violence or stalking.

Bystander intervention includes:

 Recognizing situations of potential harm.

 Understanding institutional structures and cultural conditions that facilitate violence, overcoming barriers

to intervening, identifying safe and effective intervention options, and taking actions to intervene.

 Risk reduction: options designed to decrease perpetration and bystander inaction, and to increase

empowerment for victims in order to promote safety and to help individuals and communities address

conditions that facilitate violence.

SEX OFFENDER REGISTRATION

Sex offenders are required to register with the police in the jurisdiction in which they reside and at

institutions of higher learning if they are students or if they work as employees, contractors, or volunteers.

Sex offenders who may be required to register should do so at the Cerritos College Police Department,

located on the south side of campus at 11090 New Falcon

ay, Cerritos CA 90703.

Information regarding registered sex offenders in the S t a t e of California can be obtained through

the Megan’s’ Law website, located at www.meganslaw.ca.gov. This information is also available, to

the public, at some local police departments and sheriff’s offices.

The Cerritos College Police Department does not provide public access to the Department of Justice

Megan’s Law program. There are several agencies in the local community where a member of the

public can access this information.

Public access to viewing the Megan’s Web program is generally by appointment, and it is recommended

that you call the agency before going to find out what hours the information is accessible.

CRIME STATISTICS

The following information is provided as part of Cerritos College’s continuing commitment to safety and

security on campus in compliance with the Jeanne Clery Disclosure of Campus Security Policy and

Page 11 of 15

Campus Crime Statistics Act. Crime statistics from more than 600 U.S. colleges, universities and career

schools can be found at the website http://ope.ed.gov/security.

Campus crime, arrest and referral statistics include those reported to the Campus Police Department,

local law enforcement agencies and District Staff with significant responsibility for the student and

campus activities.

Criminal Offenses - On Campus

2013

2014

2015

Murder/Non-negligent

manslaughter

Negligent manslaughter

Sex offenses – Forcible

Rape

Fondling

Sex offenses - Non-forcible

Incest

Statutory Rape

Robbery

Aggravated assault

Burglary

Motor vehicle theft

Arson

Domestic Violence

Dating Violence

Stalking

Crimi

nal Offenses - Public Property

2013

2014

2015

Murder/Non-negligent

manslaughter

Negligent manslaughter

Sex offenses - Forcible

Sex offenses - Non-forcible

Incest

Statutory Rape

Robbery

Aggravated assault

Burglary

Motor vehicle theft

Arson

Domestic Violence

Dating Violence

Stalking

Arres

ts - On Campus

2013

2014

2015

Illegal weapons possession

Drug law violations

Liquor law violations

Page 12 of 15

Discip

linary Actions/Judicial Referrals - On Campus

2013

2014

2015

Illegal weapons possession

Drug law violations

Liquor law violations

Arres

ts - Public Property

2013

2014

2015

Illegal weapons possession

Drug law violations

Liquor law violations

Discip

linary Actions/Judicial Referrals - Public Property

2013

2014

2015

Illegal weapons possession

Drug law violations

Liquor law violations

Page 13 of 15

HATE CRIMES

Any crime will be reported in which the victim is intentionally selected because of his or her actual or

perceived race, religion, sexual orientation, gender identity, disability, ethnicity, or national origin.

Category of Bias for Crimes Reported in 2013

Hate Crimes - On Campus (2013)

Total Race Religion

Sexual

Gender Disability

Orientation

Ethnicity /

National

origin

Murder/Non-negligent

manslaughter

Negligent manslaughter

Sex offenses - Forcible

Sex offenses - Non-forcible

Robbery

Aggravated assault

Burglary

Motor vehicle theft

Arson

Simple Assault

Larceny-theft

Intimidation

Destruction/damage/vandalism of

property

Category of Bias for Crimes Reported in 2014

Hate Crimes - On Campus (2014)

Total Race Religion

Sexual

Gender Disability

Orientation

Ethnicity /

National

origin

Murder/Non-negligent

manslaughter

Negligent manslaughter

Sex offenses - Forcible

Sex offenses - Non-forcible

Robbery

Aggravated assault

Burglary

Motor vehicle theft

Arson

Simple Assault

Larceny-theft

Intimidation

Destruction/damage/vandalism of

property

Page 14 of 15

Category of Bias for Crimes Reported in 2015

Hate Crimes - On Campus (2015)

Total Race Religion

Sexual

Gender Disability

Orientation

Ethnicity /

National

origin

Murder/Non-negligent

Manslaughter

Negligent manslaughter

Sex offenses - Forcible

Sex offenses - Non-forcible

Robbery

Aggravated assault

Burglary

Motor vehicle theft

Arson

Simple Assault

Larceny-theft

Intimidation

Destruction/damage/vandalism of

property

Category of Bias for Crimes Reported in 2013

Hate Crimes - Public Property (2013)

Total Race Religion

Sexual

Gender Disability

Orientation

Ethnicity /

National

origin

Murder/Non-negligent

Manslaughter

Negligent manslaughter

Sex offenses - Forcible

Sex offenses - Non-forcible

Robbery

Aggravated assault

Burglary

Motor vehicle theft

Arson

Simple Assault

Larceny-theft

Intimidation

Destruction/damage/vandalism of

property

Page 15 of 15

Category of Bias for Crimes Reported in 2014

Hate Crimes - Public Property (2014)

Total Race Religion

Sexual

Orientation

Gender Disability

Ethnicity /

National

origin

Murder/Non-negligent

manslaughter

Negligent manslaughter

Sex offenses - Forcible

Sex offenses - Non-forcible

Robbery

Aggravated assault

Burglary

Motor vehicle theft

Arson

Simple Assault

Larceny-theft

Intimidation

Destruction/damage/vandalism of

property

Category of Bias for Crimes Reported in 2015

Hate Crimes - Public Property (2015)

Total Race Religion

Sexual

Gender Disability

Orientation

Ethnicity /

National

origin

Murder/Non-negligent

Manslaughter

Negligent manslaughter

Sex offenses - Forcible

Sex offenses - Non-forcible

Robbery

Aggravated assault

Burglary

Motor vehicle theft

Arson

Simple Assault

Larceny-theft

Intimidation

Destruction/damage/vandalism of

property

Employee Feedback

The Human Resources Department strives for high quality service at all times. We ask that you

complete this survey to help assess our services. Your input is valuable as you have become

part of the Cerritos family and your honest assessment of our services in the Human Resources

Department will help us better serve our employees.

This survey is confidential (no name required) and it will not affect you in anyway during your

employment with the District. We encourage your comments on all aspects of any service.

RECRUITMENT AND SELECTION

Statement

Strongly

Agree

Disagree

Strongly

Disagree

Comment

Staff was courteous and helpful



Staff provided complete and accurate

information to you



A timely response was provided



Instructions and documents provided by

the HR Department were clear



My overall experience was positive



Comments:

HUMAN RESOURCES PROCESSING

Statement

Strongly

Agree

Disagree

Strongly

Disagree

Comment

Staff was courteous and helpful



Classification:

 Faculty  Classified  Confidential  Management

Academic Year Hired:

 Full-time  Part-time

Cerritos College

Office of Human Resources

(562) 860-2451, Extension 2284

www.cerritos.edu/hr

CONTINUE ON BACK…

Staff provided complete and accurate

information to you



A timely response was provided



Instructions and documents provided by

the HR Department were clear



My overall experience was positive



Comments:

BENEFITS

Statement

Strongly

Agree

Disagree

Strongly

Disagree

Comment

Staff was courteous and helpful



Staff provided complete and accurate

information to you



A timely response was provided



Instructions and documents provided by

the HR Department were clear



My overall experience was positive



Comments:

Thank you for taking the time to complete this assessment.

Please return this form by inter-office or U.S. mail to:

Dr. Adriana Flores-Church

Director, Human Resources/Risk Management

Cerritos College

11110 Alondra Blvd.

Norwalk, CA 90650

(Please mark CONFIDENTIAL on the envelope)

Cerritos College

Rideshare Bulletin

My name is Michelle Wheatley and I am the Employee Transportation Coordinator for

Cerritos College. If you would like information on carpooling please feel free to contact

my office at extension #2326 or via email at mwheatley@cerritos.edu .

To assist your commute, I have provided several links below for your information on

carpooling, traffic information, daily air quality, etc.

Metro’s Commute Services go to their web site at:

www.metro.net/riding_metro/commute_services/share.htm

For real time traffic information:

www.commutesmart.info/trafficupdates/index.html

For local air quality and conditions:

http://airnow.gov/index.cfm?action=airnow.showlocal&CityID=130

Caltrans Live Traffic Camera and Traffic Information:

http://video.dot.ca.gov/

Caltrans Traveler Services:

http://www.dot.ca.gov/roadsandtraffic.html

California Highway Patrol Traffic Incident Information Page:

http://cad.chp.ca.gov/

Links to other Local Transit Agencies and Bus Line #’s

Line #1 http://www.ci.cerritos.ca.us/where/COW_new.html

Norwalk Transit Line # 2 & 3 http://www.ci.norwalk.ca.us/transportation.asp

Line # 172 & 173 http://www.lbtransit.com/

Line #128 http://www.metro.net/riding_metro/default.htm

http://www.octa.net/

Buckle Up! Remember to wear your seatbelt while driving.

www.aqmd.gov

CERRITOS COLLEGE POLICE DEPARTMENT

Memorandum

TO: New or Re-Active Rideshare Participant

FROM: Michelle Wheatley, Parking Coordinator/Campus Police Department

DATE: January 20, 2016

RE: Rideshare Sign-up Application

Welcome to Cerritos College! My name is Michelle Wheatley and I am the Employee

Transportation Coordinator for Cerritos College. The Employee Commute Rideshare

Program is offered to all employees of Cerritos College with the benefit of earning up to six

(6) hours of vacation time per quarter or up to $45.00 cash per quarter. Only full-time

employees have the option of receiving either vacation hours or pay, all part-time employees

are offered only the cash benefit.

Attached is the alternative transportation program application. Please fill out the first two

pages and return to my office at the Campus Police Department. Once your application is

received and processed, you will receive a “Certified Carpooler” parking permit that will be

used in conjunction with your staff parking permit to park in the designated Carpool Parking

spaces which are located throughout the campus. If you have any carpool partner(s), they also

need to request an application and return it to my office.

Please make your own copies of the Monthly Alternative Transportation Verification Form

that is attached, as it will be the only one accepted in the ride share program; this form needs

to be turned in at the end of each month, but no later than the 3

working day after the

end of the month you are reporting. Late forms will not be accepted. Please make sure that

you read the instructions for completing the form and that the form is completely filled out

and signed by you and your immediate supervisor.

Thank you for joining the effort to clean up our air. If you have any questions, please feel free

to contact me, Michelle Wheatley, at extension #2326 or at mwheatley@cerritos.edu

CERRITOS COLLEGE –EMPLOYEE RIDESHARING AGREEMENT

The below listed employee/employees hereby agree to the following provisions of the Cerritos

College Ridesharing Agreement:

1. Each member will purchase a parking permit.

2. Each member will display their individual staff parking permit so they are clearly visible.

3. Each member bringing a student to any school campus, a child to a child daycare center, or a

babysitter must request a carpool pass to display with their parking permit from the ETC.

Cerritos College agrees to assist the below listed employees by providing the following:

1. A carpool pass giving access to parking stalls that are provided in varies lots on campus

intended for the use of rideshare participants only.

2. A guaranteed ride home for any member of the rideshare group who needs to leave due to

illness of family emergency.

Print Name Employee # & SS # Parking Permit #

_______________________________ ___________________________ _____________________

The undersigned agrees to abide by the terms of this agreement and to notify the college Employee

Transportation Coordinator if there any changes or additions to this rideshare group. Each member

of the rideshare group must sign and date below. Each member of the rideshare group must submit a

separate enrollment form and ridesharing agreement.

Signature Date

___________________________________ ___________________________________

CERRITOS COLLEGE – EMPLOYEE RIDESHARING AGREEMENT

I, _____________________________, have been working the hours of ______________ to _______________

(do not use military time). My employee # is ______________ and my Social Security # is

____________________________

. I hereby agree to enroll in the Cerritos College Alternative

Transportation Program by participating in one or more of the following activities for at least

51% of my total trip to work.

1. Walking to work.

2. Riding a bicycle to work.

3. Riding a bus to work or taking a train.

4. Participating in a rideshare group. (any vehicle with 2+ occupants)

5. Other alternative to driving along (i.e. childcare, 9/80 work schedule, dropped off by

another employee from a different employer, riding with a student, dropped off a child

or student at a school, ride to work with another employee, etc.).

Cerritos College agrees to pay me one dollar twenty-five cents ($1.25)* or ten (10) minutes of

vacation time (classified and management employees only) for each point that I earn by

participating in one or more of the above activities. Incentives will be paid at the end of each

three (3) month quarter. Vacation time will be rounded up if over one-half (1/2) of a fifteen

(15) minute increment or rounded down if less than one-half (1/2) of a fifteen (15) minute

increment. A MAXIMUM OF THIRTY-SIX (36) POINTS WILL BE PAID PER QUARTER.

I elect:

□ To be paid a taxable monetary incentive which will be included in my regular payroll

warrant at the end of each quarter (available to all employees).

□ To earn a vacation incentive which will be kept on file in the payroll department (classified

and management only).

Participant: ______________________________ ______________ _______________

Signature Ext. Date

Received by: _____________________________ ______________ _______________

ETC Ext Date

ATP-1 Rev. (01/04)

CERRITOS COLLEGE

ALTERNATIVE TRANSPORTATION VERIFICATION FORM

NAME:

SS#

Print Last, First

WORK LOCATION:

EMP #

HOURLY/FACULTY

CLASSIFIED

MANAGEMENT

VERIFICATION FOR:

Month

Year

TOTAL DAYS: _______

INSTRUCTIONS FOR COMPLETION OF THIS FORM:

1. Mark an activity code in the above calendar for each day you participated, leave any days

driven alone blank.

2. Obtain immediate manager’s signature for verification.

3. Sign and date the form.

4. Submit this form to the Employee Transportation Coordinator-Michelle Wheatley at

Campus Police no later than 3 working days after the end of each month.

5. Form must be filled out completely to receive credit.

6. Form must be signed by manager before submitting to get credit. Any forms sent

without manager’s signature will not be given credit for that month.

Activity Codes:

(W) Walking (R) Ridesharing (T) Bus/Mass Transit (O) 9/80-4/10 (B) Bicycling

(M) Motorcycle (C) Child Care (D) Pick up/Drop Off (H) Hybrid/CNG (E) Electric Vehicle

ALTERNATIVE TRANSPORTATION INCENTIVES

MUST BE CIRCLED TO BE CREDITED QUARTERLY

VACATION CASH

I certify attendance as shown:

Signature of Immediate Manager

Extension

Date

I certify that I have participated in the Alternative Transportation Program as indicated above and in

accordance with the provisions of the enrollment agreement signed by me. Any falsification will immediately

terminate my enrollment in the program.

Signature of Participant

Extension

Date

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

OFFICE USE ONLY

Eligible Days: _____________ Vacation:__________ Cash:___________ ATP-4/09

VACATION

Cerritos College

Human Resources

MEMO TO: New Employees

FROM: Human Resources Office

SUBJECT: TUBERCULOSIS EXAMINATION REQUIREMENT

In order for you to receive clearance for employment at Cerritos College, the District policy

requires that you obtain and submit to the Human Resources Office, the results of a tuberculosis

screening examination, which verifies that you are free of active tuberculosis.

To fulfill this requirement, you may use your personal physician or a public health facility. For

your convenience, on the reverse side of this memorandum there is a listing of public health

facilities where tuberculin tests can be obtained.

Revised

01/2017

TUBERCULOSIS REFERRAL

1. Hawaiian Garden Health Center

22310 Wardham Ave.

Hawaiian Gardens, CA. 90716

(562) 420-2433

WALK-IN ONLY

Monday – Wednesday, & Friday (1pm – 3pm)

Thursday (8am – 11am)

TB skin test cost: $25.00

Chest X-Ray: NOT AVAILABLE

2. Long Beach Health Department

2525 Grand Ave., Room # 104

Long Beach, CA. 90815

(562) 570-7912

BY APPOINTMENT ONLY

Monday – Wednesday, & Friday only (8am – 11am, 1pm – 4pm)

TB skin test cost: $32.00

Chest X-Ray: $58.00 (Monday, Wednesday, & every other Friday)

3. Cerritos College Student Health Center

Summer;

Monday & Tuesday only - 8:00 am - 2:00 pm

Spring & Fall;

Monday & Tuesday 8:00 am - 2:00 pm

Wednesday 8:00 am - 10:00 am

Thursday – (NO TB TESTING)

Friday 9:00 am - 11:00 am

TB skin test cost: $15.00

Chest X-Ray: NOT AVAILABLE

(562) 860-2451 Ext. 2321

Web Resources:

www.cdc.gov/tb/

www.dhhs.gov

www.healthfinder.gov

www.labtestsonline.org

www.lapublichealth.org/tb/faq/skinqa.htm

www.nih.gov

Cerritos Community College District

Management Employees Salary Schedule*

Effecrive Date: 7/1/2017**

Grade Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8

45 13,212 13,648 14,098 14,563 15,044 15,541 16,054 16,585

44 12,790 13,212 13,648 14,098 14,563 15,044 15,541 16,054

43 12,382 12,790 13,212 13,648 14,098 14,563 15,044 15,541

42 11,986 12,382 12,790 13,212 13,648 14,098 14,563 15,044

41 11,603 11,986 12,382 12,790 13,212 13,648 14,098 14,563

40 11,232 11,603 11,986 12,382 12,790 13,212 13,648 14,098

39 10,871 11,232 11,603 11,986 12,382 12,790 13,212 13,648

38 10,520 10,871 11,232 11,603 11,986 12,382 12,790 13,212

37 10,180 10,520 10,871 11,232 11,603 11,986 12,382 12,790

36 9,852 10,180 10,520 10,871 11,232 11,603 11,986 12,382

35 9,536 9,852 10,180 10,520 10,871 11,232 11,603 11,986

34 9,227 9,536 9,852 10,180 10,520 10,871 11,232 11,603

33 8,932 9,227 9,536 9,852 10,180 10,520 10,871 11,232

32 8,643 8,932 9,227 9,536 9,852 10,180 10,520 10,871

31 8,364 8,643 8,932 9,227 9,536 9,852 10,180 10,520

30 8,095 8,364 8,643 8,932 9,227 9,536 9,852 10,180

29 7,834 8,095 8,364 8,643 8,932 9,227 9,536 9,852

28 7,581 7,834 8,095 8,364 8,643 8,932 9,227 9,536

27 7,338 7,581 7,834 8,095 8,364 8,643 8,932 9,227

26 7,101 7,338 7,581 7,834 8,095 8,364 8,643 8,932

25 6,874 7,101 7,338 7,581 7,834 8,095 8,364 8,643

24 6,650 6,874 7,101 7,338 7,581 7,834 8,095 8,364

23 6,436 6,650 6,874 7,101 7,338 7,581 7,834 8,095

22 6,231 6,436 6,650 6,874 7,101 7,338 7,581 7,834

*Advancement from one step to the next on the appropriate salary schedule shall be dependent upon the recommendation

of the manager's immediate supervisor and subject to approval by the President/Superintendent. (AP 7250)

**Approved by the Board of Trustees: April 5, 2017

Cerritos Community College District Procedure No. 3050

General Institution

AP 3050 INSTITUTIONAL CODE OF ETHICS

Reference: 2

Accreditation Standard III.A.1.d 3

Definition of Ethics 4

Ethical behavior is often defined as “right” or “good” behavior as measured against 5

commonly accepted rules of conduct for a society or for a profession. The ethical 6

person is often described in absolute terms as one who is fair, honest, straightforward, 7

trustworthy, dispassionate, and unprejudiced. If, however, one is inconsistently fair or 8

honest, one loses credibility and is perceived to be unethical. The ethical person must 9

be conspicuously consistent in the exercise of integrity to sustain the credibility that is 10

an expectation of office. 11

Importance of Ethics 12

The credibility of the District’s employees depends upon whether they are perceived as 13

honest men and women. If integrity contributes to credibility, then ethical behavior is a 14

singular prerequisite to successful performance. 15

Statements of ethical standards do not necessarily ensure ethical behavior. Yet public 16

statements of intent surely create an expectation that employees will indeed act with 17

integrity in the public interest. 18

Expectations for Ethical Behavior 19

Employees of the District shall be committed to the principles of honesty and equity. 20

They shall not seek to abridge for any purpose the freedoms of other employees or 21

students. At the same time, they shall not willingly permit the interests of any members 22

of the college community to override the best interests of the public served by the 23

District. 24

Employees shall exercise judgments that are dispassionate, fair, consistent, and 25

equitable. They shall exhibit openness and reliability in what they say and do as 26

educational leaders. They shall confront issues and people without prejudice. They 27

shall demonstrate a commitment to excellence in education and uncompromising 28

commitment to the principles of ethical behavior. 29

Similarly, students are expected to abide by ethical behavior and decision-making in 30

their treatment of District employees, other students, and members of the public. 31

Employee Responsibilities 32

As practitioners of ethical behavior, District personnel have a responsibility: 33

 to provide and protect student access to the educational resources of the District;34

 to protect human dignity and individual freedom, and assure that students are35

respected as individuals, as learners, and as independent decision-makers;36

 to protect students from disparagement, ridicule, or capricious judgment;37

 to keep foremost in mind at all times that the District exists to serve students;38

 to foster a climate of trust and mutual support;39

 to foster openness by encouraging and maintaining two-way communication;40

 to encourage, support, and abide by the written Board Policies and41

Administrative Procedures of the District; and42

 to challenge unethical behavior in a timely manner.43

Office of Primary Responsibility: Office of the President/Superintendent 44

Date Approved: November 26, 2007

AUGUST 2010

alifornia law guarantees certain benefits to

employees who are injured or become ill

because of their jobs.

Any job related injury or illness is covered.

Types of injuries include, but may not be

limited to, strains, sprains, cuts, cumulative

or repetitive traumas, fractures, illnesses and

aggravations. Some injuries from voluntary,

off duty, recreational, social or athletic

activity may not be covered. Check with

your supervisor or Keenan HealthCare if

you have any questions.

All work related injuries must be reported

to your supervisor immediately. Don’t

delay. There are time limits. If you wait too

long, you may lose your right to benefits.

Your employer is required to provide you a

claim form within one working day after

learning about your injury.

It is a misdemeanor for an employer to

discriminate against workers who are

injured on the job or who testify in another

employee’s case. Any such employee may

be entitled to compensation, reinstatement

and reimbursement for lost wages and

benefits.

dical Care – All medical treatment,

without a deductible or dollar limit. For

dates of injury on or after 1/1/04 there is a

limit of 24 chiropractic, 24 physical therapy

and 24 occupational therapy visits. However

this limit does not apply for post surgical

treatment. Costs are paid directly by Keenan

HealthCare, through your employers

workers’ compensation program, so you

should never see a bill.

If emergency treatment is required go to the

nearest emergency room or contact 911.

Keenan HealthCare will arrange medical

treatment, often by a specialist for the

particular injury. Preferred Provider

Networks may be utilized for physicians as

well as medical care centers.

If your employer offers group health

insurance you are eligible to treatment with

your personal physician should you become

injured on the job. If you are eligible,

before you are injured

, you must notify

your employer in writing and provide your

employer written documentation from your

personal physician that they agree to be

predesignated. Your personal physician

must be your regular primary care physician

who previously directed your medical

treatment, who retains your medical history

and records. You may only predesignate

your primary care physician if they are a

family practitioner, general practitioner,

board certified or board eligible internist,

obstetrician-gynecologist, pediatrician or a

multi-specialty medical group, whose

practice is predominantly for non-

occupational injuries and illnesses.

Your employer may be using a Medical

Provider Network (MPN), which is a

selected group of health care providers to

provide treatment to workers injured on the

job. If you have predesignated a personal

physician prior to your work injury, then

you may receive treatment from your

predesignated doctor. If you have not

predesignated and your employer is using

and MPN, you are free to choose an

appropriate provider from the MPN list

after the first medical visit directed by your

employer or Keenan & Associates. For

more information, see the MPN contact

information on reverse side.

If your employer does not

participate in a

Medical Provider Network (MPN) you may

be able to change your treating physician to

your personal chiropractor or acupuncturist.

Generally your employer, or Keenan, has

the right to select your treating physician

within the first 30 days after your employer

knows of your injury or illness. After your

employer, or Keenan, initiates treatment

you may, upon request, have your treatment

transferred to your personal chiropractor or

acupuncturist. To be eligible you must

notify your employer in writing prior to

being injured.

If a work injury occurs

pamphlet

Workers’ compensation benefits include

AUGUST 2010

Your employer will provide you with a form

to use an optional method to predesignate

your personal physician

ontact Keenan HealthCare if you plan to

change physicians at any time.

Payment for Lost Wages - If you’re

temporarily disabled by a job injury or

illness, you’ll receive tax-free income until

your doctor says you are able to return to

work. Payments are two-thirds of your

average weekly pay, up to a maximum set by

state law. Payments aren’t made for the first

three days unless you are hospitalized in an

inpatient basis or unable to work more than

14 days.

If the injury or illness results in permanent

disability, additional payments will be made

after recovery. If the injury results in death,

benefits will be paid to surviving

dependents.

You may be entitled to a

Supplemental

Job Displacement Voucher

, which

entitles you to a voucher for educational

training.

Contact your employer representative or

Keenan HealthCare if you have questions

about workers’ compensation benefits. You

may also contact and Information and

Assistance Officer at the State Division of

Workers’ Compensation. You can consult

an attorney. Most attorneys offer one free

consultation. If you decide to hire an

attorney, his or her fee will be taken out of

some of your benefits. For names of

workers’ compensation attorneys, call the

State Bar of California at 415-538-2120.

You can get free information from a state

Division of Workers’ Compensation

Information & Assistance Officer. The

phone numbers are listed below. Hear

recorded information by calling toll-free

800-736-7401 or visit www.dwc.ca.gov.

Anaheim 714-414-1801

Bakersfield 661-395-2514

Eureka 707-441-5723

Fresno 559-445-5355

Goleta 805-968-4158

Long Beach 562-590-5001

Los Angeles 213-576-7389

Marina Del Rey 310-482-3858

Oakland 510-622-2861

Oxnard 805-485-3528

Pomona 909-623-8568

Redding 530-225-2047

Riverside 909-782-4347

Sacramento 916-263-2741

Salinas 831-443-3058

San Bernardino 909-383-4522

San Diego 619-767-2170

San Francisco 415-703-5020

San Jose 408-277-1292

San Luis Obispo 805-596-4159

Santa Ana 714-558-4597

Santa Monica 310-452-1188

Santa Rosa 707-576-2452

Stockton 209-948-7980

Van Nuys 818-901-5367

Torrance (MPN Contact)

800-654-8102

How to obtain additional information

Department of Workers’ Compensation

Information and Assistance Offices

Keenan H

ealthCare adjusting locations

Cerritos Community College District Procedure No. 3518

General Institution

AP 3518 CHILD ABUSE AND NEGLECT REPORTING

1

References: 2

Penal Code, Sections 261, 264.1, 273a, 273d, 285, 286, 288, 288a, 289, 647a, 3

and 11164-11174.3 (“Child Abuse and Neglect Reporting Act); 4

Welfare and Institutions Code, Sections 300, 305, 318, and 601; 5

Family Code, Sections 7802, 7807, 7808, 7820-7829, 7890, and 7892 6

The District recognizes the responsibility of its staff to report to the appropriate agency 7

when there is a reasonable suspicion that an abuse or neglect of a child (under the age 8

of 18 years) may have occurred. 9

“Reasonable suspicion” occurs when “it is objectively reasonable for a person to 10

entertain such a suspicion, based upon facts that could cause a reasonable person in a 11

like position, drawing, when appropriate, on his or her training and experience, to 12

suspect child abuse or neglect.” (Penal Code, Section 11166(a)(1)) 13

Definition of Child Abuse or Neglect 14

“Child abuse” is defined as physical abuse, sexual abuse, and/or serious emotional 15

maltreatment, as well as sexual assault, sexual exploitation, and/or the willful cruelty or 16

unjustifiable punishment of a child; incidents of unlawful corporal punishment or injury 17

against a child; or abuse in out-of-home care. (Penal Code, Section 11165) 18

“Neglect” means the negligent treatment or maltreatment of a child by a person 19

responsible for the child’s welfare under circumstances indicating harm or threatened 20

harm to the child’s health or welfare. It includes the negligent failure of a person having 21

the care or custody of a child to provide adequate food, clothing, shelter, medical care, 22

or supervision such that the child’s health is endangered. (Penal Code, Section 23

11165.2) 24

Mandated Reporters 25

Mandated reporters include faculty members, educational administrators, and classified 26

staff. Volunteers are not mandated reporters but are encouraged to report suspected 27

abuse or neglect of a child. (Penal Code, Section 11165 (b)) 28

Reports of Child Abuse or Neglect 29

If a mandated reporter suspects child abuse or neglect, he or she must first make a 30

verbal report to the Department of Children & Family Services Child Protection Hotline 31

at 1-800-540-4000. 32

Mandated reporters must report immediately any reasonable suspicion of child abuse to 33

a local child protective agency such as the Hotline and follow up with a written report 34

within 36 hours. (Penal Code, Section 11166(a)) 35

After a verbal report of abuse or neglect is made, the Hotline will provide mandated 36

reporters with a 19-digit referral number which will be needed to complete the 37

mandatory written report. This report of child abuse and/or neglect must be made on 38

Form SS 8572; copies of this form are available in the Human Resources Office, 39

through the Child Development Center and on the web at 40

https://mandreptla.org/onlineRep.htm. 41

Once the written report of child abuse or neglect is completed, it should be mailed to the 42

following address: 43

Child Protection Hotline 44

3075 Wilshire Boulevard, Fifth Floor 45

Los Angeles, CA 90010 46

Immunity and Failure to Report when Required 47

No mandated reporter who reports a known or suspected instance of child abuse shall 48

be civilly or criminally liable for any report required or authorized by the Penal Code. 49

Any person other than a child care custodian reporting a known or suspected instance 50

of child abuse shall not incur any liability as a result of making any report of child abuse, 51

unless it can be proven that a false report was made and the person knew that the 52

report was false (Penal Code, Section 11172(a)). 53

Any person not mandated by law to report suspected child abuse has immunity unless 54

the report is proven to be false and the person reporting knows it is false, or the report is 55

made with reckless disregard of the truth or falsity of the incident (Penal Code, Section 56

11172(a)). 57

Reporting is an individual responsibility. An employee making a report cannot be 58

required to disclose his or her identity to the employer. (Penal Code, Section 59

11166(h)(2)) However, a person who fails to make a required report is guilty of a 60

misdemeanor punishable by up to six months in jail and/or up to a $1,000 fine (Penal 61

Code, Section 11166.5(b)). 62

Obligation and Compliance Information Provided to Mandated Reporters

63

The District shall provide each mandated reporter with a statement informing him or her 64

of the fact that he or she is a mandated reporter and of his or her reporting obligations 65

and confidentiality rights under Penal Code, Section 11166.5(a) and of his or her 66

confidentiality rights under subdivision Penal Code, Sections 11166.5(a) and 67

11167(d)(1). 68

The District shall provide a copy of Penal Code, Sections 11165.7 (Mandated Reporter),

69

11166 (Report: Duty, Time & Method), and 11167 (Report: Confidentiality of persons 70

reporting) to each mandated reporter, along with the statement. Prior to commencing 71

his or her employment and as a prerequisite to that employment, the employee shall 72

sign and return the statement to the District. The signed statements shall be retained 73

by the District (Penal Code, Section 11166.5). 74

The District shall distribute this procedure to all mandated reporters.

75

Offices of Primary Responsibility: Vice President, Student Services 76

Human Resources 77

Date Approved: November 26, 2007

Date Revised: June 18, 2008

Cerritos Community College District

Request for Transfer of Sick Leave

1. STATEMENT OF TRANSFERRING EMPLOYEE:

This is to certify that I,

(Name) (Social Security #)

was employed by

District.

Address:

I was employed in a

certificated

non-certificated capacity:

From: To:

Signature of Employee: Date

2. REQUEST BY EMPLOYING DISTRICT

The above named person has been employed by this District. This is to request that the

amount of unused sick leave due the above named employee be transferred to this District.

(Ed Code §87782, 87783, 87785, and 88202)

Human Resources Office

Cerritos Community College District

11110 Alondra Blvd Norwalk, CA 90650

(562) 860-2451, Extension 2284

Fax Number: (562) 467-5003

______________________________________________________ ________________________________________

Dr. Adriana Flores-Church Date

Director of Human Resources/Risk Management

3. RESPONSE BY FORMER DISTRICT

This is to certify that the above named person was employed by this District

from to and that the following

information is true and correct.

Total Earned Sick Leave days

hours

Minus Used Sick Leave days

hours

Total Sick Leave Being Transferred days

hours

Signature Date

Print Name Title

(Upon completion, please return this form to the requesting District’s address or via FAX as shown in item #2 above)

Revised 10/08

(800) 531-0200

California State Teachers’ Retirement System

P.O. Box 15275

Sacramento CA 95851-0275

800-228-5453

CalSTRS.com

COM 1519 (rev 1/14)

MEMBER HANDBOOK Your Guide to CalSTRS Benets 2014

Link to STRS Handbook

MEMBER HANDBOOK

Your Guide to CalSTRS Benets

2014

WEB

CalSTRS.com

Click Contact Us to email

myCalSTRS.com

403bCompare.com

Pension2.com

STAY CONNECTED

CALL

800-228-5453

7 a.m. to 6 p.m.

Monday through Friday

888-394-2060

CalSTRS Pension2®

Personal Wealth Plan

855-844-2468 (toll free)

Pension Abuse Reporting Hotline

WRITE

CalSTRS

P.O. Box 15275

Sacramento, CA

95851-0275

VISIT

Member Services

100 Waterfront Place

West Sacramento, CA 95605

Find your nearest

CalSTRS ofce at

CalSTRS.com/localofces

FAX

916-414-5040

CalSTRS Resources

Links to Employee Bargaining Agreements

CSEA Bargaining Agreement

CCFF Bargaining Agreement

To be valid, this form must be received and accepted by

CalSTRS before your death.

The Recipient Designation form replaces the One-Time Death

Beneﬁt Recipient form and the Cash Balance Beneﬁciary

Designation form. If you have one of these forms currently

on ﬁle with CalSTRS, you do not need to submit a new

Recipient Designation form unless you wish to make a

change to your recipient designation.

DEFINED BENEFIT PROGRAM MEMBERS

Use this form to designate recipients to receive the one-

time beneﬁt that may be payable in the event of your death.

If you are an active member at the time of your death,

and if you did not elect an option beneﬁciary to receive a

continuing beneﬁt after your death, or you have no spouse,

registered domestic partner or children eligible to receive a

family or survivor beneﬁt allowance after your death, any

accumulated contributions in your account will be paid to

your designated recipients.

If your death occurs before retirement, your recipients may

be eligible to receive the balance in your Deﬁned Beneﬁt

Supplement account as an ongoing annuity or a lump-

sum payment. If your death occurs after retirement, your

recipients may be eligible for the ongoing annuity you

elected at retirement.

This form will not protect your survivor with a lifetime

beneﬁt. To provide your survivors with a lifetime beneﬁt,

submit the Preretirement Election of an Option form when

you are eligible to retire.

CASH BALANCE BENEFIT PROGRAM PARTICIPANTS

Use this form to designate recipients to receive the lump-

sum payment in the event of your death.

If you are receiving an annuity at the time of your death,

the beneﬁt payable is determined based on the annuity

you elected.

If your recipient’s (other than an entity) share of your

account balance is at least $3,500, he or she may elect to

receive an annuity in place of a lump-sum payment.

IMPORTANT FACTS

• This form remains in effect until either you submit

another valid Recipient Designation form, or your

membership in CalSTRS is terminated by a refund of

your accumulated contributions. It is important to keep

this form current.

• If your designated primary recipients predecease

you, any beneﬁt due will be paid to your secondary

recipients, unless you submit a valid Recipient

Designation form designating new recipients. If we are

unable to locate your designated recipients, the death

beneﬁt will be distributed to the best of our ability

according to the laws in existence at the time of your

death.

• If you do not have a valid Recipient Designation form

on ﬁle with CalSTRS before your death or if all your

designated recipients predecease you, any beneﬁt due

will be paid to your estate.

• You may change your recipient designations at any

time—before or after retirement. There is no fee or

ﬁnancial penalty for changing your designation.

Recipient Designation Form–Information

One-Time Death Beneﬁt/Cash Balance Lump-Sum Payment

RECIPIENT DESIGNATION FORM INSTRUCTIONS • REV 01/15 • PAGE 1 OF 2

Complete and submit this form online using your

myCalSTRS account for faster processing. Step-

by-step guidance means you complete the form

correctly.

Print clearly in dark ink or type all information

requested. Initial all corrections on the form.

Check the appropriate box to identify your CalSTRS

membership status. If you are not sure of your CalSTRS

membership, see your most recent Retirement Progress

Report, available on myCalSTRS.

If you are both a Deﬁned Beneﬁt Program member and

Cash Balance Beneﬁt Program participant and you are

designating different recipients for each, you must complete

two separate Recipient Designation forms.

SECTION 1: MEMBER/PARTICIPANT INFORMATION

Enter your full name, Client ID or Social Security number,

complete mailing address, birth date, telephone number

and email address.

SECTIONS 2 AND 3: PRIMARY AND SECONDARY RECIPIENTS

OR TRUST

You may name a living person, an estate, a trust, a

corporation, a charitable organization, a parochial

institution or a public entity as your recipient.

• Persons—To designate a person or persons, check the

box and provide full name, address, telephone number,

Social Security number, birth date and relationship.

• Organization—To designate an organization, check the

box and enter the name and address of the organization

and the organization’s tax identiﬁcation number. Include

organization contact information whenever possible.

• Trust—To designate a trust, check the box and enter the

full name of the trust, the trustee’s name and address,

and the date the trust was created. CalSTRS will contact

the trustee and pay beneﬁts to the trust. You do not need

to provide the trust document at this time.

• Estate—To designate your estate, check the box and

enter “My Estate” for the recipient’s name. Upon your

death, if your estate is not subject to probate, CalSTRS

will pay beneﬁts pursuant to California Probate Code

section 13101.

Check the box on page 3 if additional recipients are listed

on an attachment. Identify each as primary or secondary.

You may designate a percentage for each recipient. If

you use percentages, the total must equal 100 percent

for the primary recipient section and 100 percent for the

secondary recipient section.

SECTION 4: REQUIRED SIGNATURES

Check all boxes that apply, then sign and date your form.

If you are married or registered as a domestic partner, your

spouse or partner must also sign and date your form

acknowledging your recipients and provide his or her

Social Security number and date of birth.

If your spouse or registered domestic partner does not

sign your form, you must complete the Justiﬁcation for

Non-Signature of Spouse or Registered Domestic Partner.

Failure to have the required signatures will result in the

rejection of your Recipient Designation form.

If you divorced or terminated a registered domestic

partnership and a portion of your CalSTRS beneﬁts was

awarded to a former spouse or partner, check the box

that indicates this. You may need to refer to your settlement

agreement. In addition, if your court documents have

not been reviewed by CalSTRS, you may be asked to

provide them.

QUESTIONS

Email your questions using your myCalSTRS account or at

CalSTRS.com/contactus, or call 800-228-5453.

SUBMITTING YOUR FORM

myCalSTRS

Complete and submit your form online using myCalSTRS.

It’s easy, fast and secure.

Hand Delivery

Hand deliver your form to a local CalSTRS beneﬁts

counseling ofﬁce (visit CalSTRS.com/localofﬁces).

Mailing Address

CalSTRS

P.O. Box 15275, MS 43

Sacramento, CA 95851-0275

Overnight Delivery

If you are using a special mailing service such as UPS

or FedEx, send your form to:

CalSTRS

Member Services

100 Waterfront Place

West Sacramento, CA 95605

Fax Delivery

916-414-5783 or 916-414-5784

Recipient Designation Form–Instructions

One-Time Death Beneﬁt/Cash Balance Lump-Sum Payment

RECIPIENT DESIGNATION FORM INSTRUCTIONS • REV 01/15 • PAGE 2 OF 2

Recipient Designation Form

One-Time Death Beneﬁt/Cash Balance Lump-Sum Payment

MS 0002 rev 01/15

California State Teachers’ Retirement System

P.O. Box 15275, MS 43

Sacramento, CA 95851-0275

800-228-5453

CalSTRS.com

This form is for designating recipients to receive the death beneﬁts payable in the event of your death under the CalSTRS Deﬁned

Beneﬁt Program and the Cash Balance Beneﬁt Program. Print clearly in dark ink or type all information requested and initial any

corrections. If you are not sure of your CalSTRS membership, see your most recent Retirement Progress Report, available on

myCalSTRS.

Check one of the following:

I am a member of the Deﬁned Beneﬁt Program. My recipient designation is for the one-time death beneﬁt payable upon

my death.

I am a participant of the Cash Balance Beneﬁt Program. My recipient designation is for the lump-sum payment to be

distributed upon my death.

I am a member/participant of both the Deﬁned Beneﬁt and Cash Balance programs. My recipient designation is for the

death beneﬁts payable under both programs. (Refer to instructions if recipients are different between programs.)

I hereby revoke any previous designations and designate the following primary recipients—or their survivors—to receive equal

amounts, unless otherwise speciﬁed as recipients for any beneﬁts payable under the Teachers’ Retirement Law at the time of my

death. If I survive the primary recipients, I designate the secondary recipients—or their survivors—to share equally unless otherwise

speciﬁed as recipients for any beneﬁts under law at the time of my death. If I survive all of my named recipients, then any beneﬁt

payable at the time of my death will be paid to my estate. I understand this form does not designate a recipient to receive a

continuing monthly retirement beneﬁt.

Complete and submit your form online using myCalSTRS for faster processing. Step-by-step guidance ensures you complete your

application correctly.

Section 1: Member/Participant Information

NAME (LAST, FIRST, INITIAL) CLIENT ID OR SOCIAL SECURITY NUMBER

MAILING ADDRESS DATE OF BIRTH (MM/DD/YYYY)

CITY STATE ZIP CODE HOME TELEPHONE

EMAIL ADDRESS

( )

Section 2: Primary Recipients

Use this area to designate one or more primary recipients to receive a death beneﬁt.

Use additional sheets if needed.

FULL NAME OF PERSON, TRUST OR ORGANIZATION

MAILING ADDRESS TELEPHONE

CITY STATE ZIP CODE

Person – Relationship: ___________________________________

Male Female

Organization – Contact Name: ____________________________

Trust

Estate

SOCIAL SECURITY NUMBER/TAXPAYER ID NUMBER/EMPLOYER ID NUMBER

DATE OF BIRTH/TRUST DATE (MM/DD/YYYY)

PERCENTAGE

(MUST TOTAL 100% FOR ALL PRIMARY RECIPIENTS)

RECIPIENT DESIGNATION FORM • REV 01/15 • PAGE 1 OF 4

Section 2: Primary Recipients continued

FULL NAME OF PERSON, TRUST OR ORGANIZATION

MAILING ADDRESS TELEPHONE

CITY STATE ZIP CODE

Person – Relationship: ___________________________________

Male Female

Organization – Contact Name: ____________________________

Trust

Estate

SOCIAL SECURITY NUMBER/TIN/EIN

DATE OF BIRTH/TRUST DATE (MM/DD/YYYY)

PERCENTAGE

(MUST TOTAL 100% FOR ALL PRIMARY RECIPIENTS)

( )

Section 3: Secondary Recipients

Use this area to designate one or more secondary recipients to receive a death beneﬁt should all of your

primary recipients predecease you. Use additional sheets if needed.

FULL NAME OF PERSON, TRUST OR ORGANIZATION

MAILING ADDRESS TELEPHONE

CITY STATE ZIP CODE

Person – Relationship: ___________________________________

Male Female

Organization – Contact Name: ____________________________

Trust

Estate

SOCIAL SECURITY NUMBER/TIN/EIN

DATE OF BIRTH/TRUST DATE (MM/DD/YYYY)

PERCENTAGE

(MUST TOTAL 100% FOR ALL SECONDARY RECIPIENTS)

( )

Recipient Designation Form continued

FULL NAME OF PERSON, TRUST OR ORGANIZATION

MAILING ADDRESS TELEPHONE

CITY STATE ZIP CODE

Person – Relationship: ___________________________________

Male Female

Organization – Contact Name: ____________________________

Trust

Estate

SOCIAL SECURITY NUMBER/TIN/EIN

DATE OF BIRTH/TRUST DATE (MM/DD/YYYY)

PERCENTAGE

(MUST TOTAL 100% FOR ALL PRIMARY RECIPIENTS)

( )

RECIPIENT DESIGNATION FORM • REV 01/15 • PAGE 2 OF 4

Recipient Designation Form continued

Check this box if additional recipients are listed on an attachment. Identify each as primary or secondary and the

percentages. Percentages must total 100% for all recipients.

FULL NAME OF PERSON, TRUST OR ORGANIZATION

MAILING ADDRESS TELEPHONE

CITY STATE ZIP CODE

Person – Relationship: ___________________________________

Male Female

Organization – Contact Name: ____________________________

Trust

Estate

SOCIAL SECURITY NUMBER/TIN/EIN

DATE OF BIRTH/TRUST DATE (MM/DD/YYYY)

PERCENTAGE

(MUST TOTAL 100% FOR ALL SECONDARY RECIPIENTS)

( )

Section 3: Secondary Recipients continued

Section 4: Required Signatures

Check all that apply.

I am married or registered as a domestic partner and both our signatures are below.

I am married or registered as a domestic partner and my spouse or partner did not sign below. I have completed and signed

the Justiﬁcation for Non-Signature of Spouse or Registered Domestic Partner section on the next page.

I have never been married or in a registered domestic partnership, or I am widowed or my partner has died.

I have been divorced or terminated a registered domestic partnership and my former spouse or partner was awarded

a portion of my CalSTRS beneﬁts.

I have been divorced or have terminated a registered domestic partnership and my former spouse or partner was not

awarded a portion of my CalSTRS beneﬁts.

I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

I understand that perjury is punishable by imprisonment for up to four years (Penal Code section 126).

I understand it is a crime to fail to disclose a material fact or to make any knowingly false material statements

for the purpose of altering a beneﬁt administered by CalSTRS and it may result in penalties, including restitution,

up to one year in jail and a ﬁne of up to $5,000 (Education Code section 22010).

MEMBER’S SIGNATURE SIGNATURE DATE (MM/DD/YYYY)

SPOUSE’S OR REGISTERED DOMESTIC PARTNER’S SIGNATURE SIGNATURE DATE (MM/DD/YYYY)

SPOUSE’S OR PARTNER’S PRINTED NAME (LAST, FIRST, INITIAL)

SPOUSE’S OR PARTNER’S SOCIAL SECURITY NUMBER SPOUSE’S OR PARTNER’S DATE OF BIRTH (MM/DD/YYYY)

RECIPIENT DESIGNATION FORM • REV 01/15 • PAGE 3 OF 4

Recipient Designation Form continued

If this form is not completely ﬁlled out, it will not be accepted and will be returned to you. Your current

recipient status will not be updated. Review your form carefully before submitting:

Did you designate at least one primary recipient and provide all the requested information?

If you designated a trust, did you provide the name and date the trust was created? Do not provide your trust

document at this time.

If you designated percentages, do they equal 100 percent for your primary recipients and 100 percent for your

secondary recipients?

Did you sign and date the form?

If you are married or in a registered domestic partnership, did your spouse or partner sign and date the form?

If you cannot obtain your spouse or partner’s signature, did you complete, sign and date the Justiﬁcation for

Non-Signature of Spouse or Registered Domestic Partner?

Justiﬁcation for Non-Signature of Spouse or Registered Domestic Partner

As required by Education Code sections 22453 and 26703, any request related to the selection of beneﬁts by a member

in which spousal or registered domestic partner interest may be present requires the signature of the spouse or registered

domestic partner unless one of the following conditions exist. If you are married or registered as a domestic partner and your

spouse or partner does not sign this form, you must check the appropriate box indicating the reason your spouse or partner

did not sign.

I do not know and have taken all reasonable steps to determine the whereabouts of my spouse or registered

domestic partner.

My spouse or registered domestic partner is incapable of executing the acknowledgment because of an

incapacitating mental or physical condition.

My current spouse or registered domestic partner has no identiﬁable community property interest in the beneﬁts.

My spouse or registered domestic partner and I have executed a settlement agreement that makes the

community property law inapplicable to the marriage or registered domestic partnership.

My spouse or registered domestic partner has refused to sign the acknowledgment. Court action will be or has been initiated

to enforce or waive the signature requirement for my spouse or partner. (CalSTRS must have a certiﬁed copy of the court

order before any designation can be made. Submit a certiﬁed copy of the court order when you receive it.) Education Code

sections 22454 and 26704

I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

I understand that perjury is punishable by imprisonment for up to four years (Penal Code section 126).

I understand it is a crime to fail to disclose a material fact or to make any knowingly false material statements for

the purpose of altering a beneﬁt administered by CalSTRS and it may result in penalties, including restitution, up to

one year in jail and a ﬁne of up to $5,000 (Education Code section 22010).

MEMBER’S SIGNATURE SIGNATURE DATE (MM/DD/YYYY)

RECIPIENT DESIGNATION FORM • REV 01/15 • PAGE 4 OF 4

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