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
M
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
A
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
*:
Na
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
nd
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
t
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
al
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
ce
Payroll will
enter the information in the county’s payroll system for a test run.
An
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
s
Co
unty Office of Education and/or my bank institution due to my failure to cancel
or
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
x
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
N
ew Change
Direct Deposit Authorization
PRINT LAST NAME, FIRST NAME, MIDDLE INITIAL SOCIAL SECURITY NUMBER
N
AME OF SCHOOL DISTRICT (IF EMPLOYED WITHIN THE OFFICE, PUT YOUR ROOM NUMBER HERE) WORK TELEPHONE NUMBER
(
)
N
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:
E
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,
w
here? ___________________________________
Full-Time ______ or Part-Time ______. What was the effective date of your membership into the
System? ___________________________.
2.
Are you a member of the California Public Employees’ Retirement System? ______ Have you withdraw
n
y
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
e
S
ystem? ________________________.
3.
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.
Si
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)
FT
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):
No
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
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 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
31
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
31
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
31
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
Annual Notice/2015
U.S. Department of Education (for discrimination in student or educational matters) Office for Civil Rights
www.ed.gov/offices/OCR
EMPLOYEE ASSISTANCE PROGRAM (EAP)
Cerritos College provides an EAP to help its employees and their immediate families with problems related to
stress; marital, working and relationship difficulties; financial and legal problems; alcohol and drug use or
addiction. Information concerning the District-paid EAP Plan may be obtained through the Office of Human
Resource Services, (562) 860-2451, extension 2284.
It is hard to be alone when you or someone you care for is having problems. Our employees are our most valuable
asset and the District encourages its employees to seek assistance when facing problems.
BOARD POLICY EXCERPTS
Board Policy 3410: Nondiscrimination
The District is committed to equal opportunity in educational programs, employment, and all access to
institutional programs and activities.
The District, and each individual who represents the District, shall provide access to its services, classes, and
programs without regard to national origin, religion, age, gender, gender identity, gender expression, race or
ethnicity, color, medical condition, genetic information, ancestry, sexual orientation, marital status, physical or
mental disability, pregnancy, or military and veteran status, or because he or she is perceived to have one or more
of the foregoing characteristics, or based on association with a person or group with one or more of these actual
or perceived characteristics.
The President/Superintendent shall establish administrative procedures that ensure all members of the College
community can present complaints regarding alleged violations of this policy and have their complaints heard in
accordance with the Title 5 regulations and those of other agencies that administer state and federal laws
regarding nondiscrimination.
Board Policy 3430: Prohibition of Harassment
All forms of harassment are contrary to basic standards of conduct between individuals and are prohibited by
state and federal law, as well as this policy, and will not be tolerated. The District is committed to providing an
academic and work environment that respects the dignity of individuals and groups. The District shall be free of
sexual harassment and all forms of sexual intimidation and exploitation including acts of sexual violence. It shall
also be free of other unlawful harassment, including that which is based on any of the following statuses: race,
religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic
information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation of any person,
or military and veteran status, or because he or she is perceived to have one or more of the foregoing
characteristics.
The District seeks to foster an environment in which all employees and students feel free to report incidents of
harassment without fear of retaliation or reprisal. Therefore, the District also strictly prohibits retaliation against
any individual for filing a complaint of harassment or for participating in a harassment investigation. Such conduct
is illegal and constitutes a violation of this policy.
Any student or employee who believes that he or she has been harassed or retaliated against in violation of this
policy should immediately report such incidents by following the procedures described in AP 3435 titled
Discrimination and Harassment Investigations. Supervisors are mandated to report all incidents of harassment
and retaliation that come to their attention.
Cerritos Community College District Policy No. 7050
Human Resources
BP 7050 EMPLOYEE CONFLICT OF INTEREST
1
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.
T
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.
A
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.
O
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
1
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
23
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
38
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
copyright and licensing restrictions and applicable District policies. Both District 77
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
Copyright/License Infringement/Mass Mailings 124
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
ON
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
st
of each year. Faculty and staff
receive similar notification via interoffice mail by October 1
st
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 Departments 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 Sheriffs 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.
W
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 Sheriffs
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 agencys 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 victims 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
W
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 Attorneys 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.
W
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
OR
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 victims 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
W
ay, Cerritos CA 90703.
CRIME PREVENTION AND AWARENESS
Cerritos College enjoys a crime rate much lower than that of the surrounding area, but, in todays society, no
community can be totally risk-free. The Campus Police Department recognizes that safety on campus is everyones
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 Districts 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 Districts 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 Districts 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 Districts 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 persons 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
ar
ea of sexual assault crisis intervention
When a sexual assault is reported to Campus Police, Campus Police may, with the victims 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
W
ay, Cerritos CA 90703.
Information regarding registered sex offenders in the S t a t e of California can be obtained through
the Megans Law website, located at www.meganslaw.ca.gov. This information is also available, to
the public, at some local police departments and sheriffs offices.
The Cerritos College Police Department does not provide public access to the Department of Justice
Megans 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 Megans 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 Colleges 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
a.
Murder/Non-negligent
manslaughter
0
0
0
b.
Negligent manslaughter
0
0
0
c.
Sex offenses Forcible
Rape
0
0
1
Fondling
0
1
0
1
d.
Sex offenses - Non-forcible
Incest
0
0
0
Statutory Rape
0
0
0
e.
Robbery
0
1
0
1
0
f.
Aggravated assault
0
0
0
g.
Burglary
6
3
5
h.
Motor vehicle theft
15
13
5
8
i.
Arson
0
0
0
j.
Domestic Violence
0
1
5
1
0
k.
Dating Violence
0
0
0
1
0
l.
Stalking
1
3
0
Crimi
nal Offenses - Public Property
2013
2014
2015
a.
Murder/Non-negligent
manslaughter
0
0
0
b.
Negligent manslaughter
0
0
0
c.
Sex offenses - Forcible
0
0
0
d.
Sex offenses - Non-forcible
Incest
0
0
0
Statutory Rape
0
0
0
e.
Robbery
0
0
0
f.
Aggravated assault
0
0
1
0
g.
Burglary
0
0
0
h.
Motor vehicle theft
0
0
0
i.
Arson
0
0
0
j.
Domestic Violence
0
0
0
k.
Dating Violence
0
0
0
l.
Stalking
0
0
0
Arres
ts - On Campus
2013
2014
2015
a.
Illegal weapons possession
1
0
1
0
1
b.
Drug law violations
2
4
2
2
2
c.
Liquor law violations
1
4
1
0
4
1
Page 12 of 15
Discip
linary Actions/Judicial Referrals - On Campus
2013
2014
2015
a.
Illegal weapons possession
0
0
1
0
b.
Drug law violations
0
0
4
0
c.
Liquor law violations
0
3
0
0
3
0
Arres
ts - Public Property
2013
2014
2015
a.
Illegal weapons possession
0
0
0
b.
Drug law violations
0
1
1
0
c.
Liquor law violations
0
0
0
Discip
linary Actions/Judicial Referrals - Public Property
2013
2014
2015
a.
Illegal weapons possession
0
0
0
b.
Drug law violations
0
0
0
c.
Liquor law violations
0
0
0
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
a.
Murder/Non-negligent
manslaughter
0
0
0
0
0
0
0
b.
Negligent manslaughter
0
0
0
0
0
0
0
c.
Sex offenses - Forcible
0
0
0
0
0
0
0
d.
Sex offenses - Non-forcible
0
0
0
0
0
0
0
e.
Robbery
0
0
0
0
0
0
0
f.
Aggravated assault
0
0
0
0
0
0
0
g.
Burglary
0
0
0
0
0
0
0
h.
Motor vehicle theft
0
0
0
0
0
0
0
i.
Arson
0
0
0
0
0
0
0
j.
Simple Assault
0
0
0
0
0
0
0
k.
Larceny-theft
0
0
0
0
0
0
0
l.
Intimidation
0
0
0
0
0
0
0
m.
Destruction/damage/vandalism of
property
property
0
0
0
0
0
0
0
Category of Bias for Crimes Reported in 2014
Hate Crimes - On Campus (2014)
Total Race Religion
Sexual
Gender Disability
Orientation
Ethnicity /
National
origin
a.
Murder/Non-negligent
manslaughter
0
0
0
0
0
0
0
b.
Negligent manslaughter
0
0
0
0
0
0
0
c.
Sex offenses - Forcible
0
0
0
0
0
0
0
d.
Sex offenses - Non-forcible
0
0
0
0
0
0
0
e.
Robbery
0
0
0
0
0
0
0
f.
Aggravated assault
0
0
0
0
0
0
0
g.
Burglary
0
0
0
0
0
0
0
h.
Motor vehicle theft
0
0
0
0
0
0
0
i.
Arson
0
0
0
0
0
0
0
j.
Simple Assault
0
0
0
0
0
0
0
k.
Larceny-theft
0
0
0
0
0
0
0
l.
Intimidation
0
0
0
0
0
0
0
m.
Destruction/damage/vandalism of
property
0
0
0
0
0
0
0
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
a.
Murder/Non-negligent
Manslaughter
0
0
0
0
0
0
0
b.
Negligent manslaughter
0
0
0
0
0
0
0
c.
Sex offenses - Forcible
0
0
0
0
0
0
0
d.
Sex offenses - Non-forcible
0
0
0
0
0
0
0
e.
Robbery
0
0
0
0
0
0
0
f.
Aggravated assault
0
0
0
0
0
0
0
g.
Burglary
0
0
0
0
0
0
0
h.
Motor vehicle theft
0
0
0
0
0
0
0
i.
Arson
0
0
0
0
0
0
0
j.
Simple Assault
0
0
0
0
0
0
0
k.
Larceny-theft
0
0
0
0
0
0
0
l.
Intimidation
0
0
0
0
0
0
0
m.
Destruction/damage/vandalism of
property
0
0
0
0
0
0
0
Category of Bias for Crimes Reported in 2013
Hate Crimes - Public Property (2013)
Total Race Religion
Sexual
Gender Disability
Orientation
Ethnicity /
National
origin
a.
Murder/Non-negligent
Manslaughter
0
0
0
0
0
0
0
b.
Negligent manslaughter
0
0
0
0
0
0
0
c.
Sex offenses - Forcible
0
0
0
0
0
0
0
d.
Sex offenses - Non-forcible
0
0
0
0
0
0
0
e.
Robbery
0
0
0
0
0
0
0
f.
Aggravated assault
0
0
0
0
0
0
0
g.
Burglary
0
0
0
0
0
0
0
h.
Motor vehicle theft
0
0
0
0
0
0
0
i.
Arson
0
0
0
0
0
0
0
j.
Simple Assault
0
0
0
0
0
0
0
k.
Larceny-theft
0
0
0
0
0
0
0
l.
Intimidation
0
0
0
0
0
0
0
m.
Destruction/damage/vandalism of
property
0
0
0
0
0
0
0
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
a.
Murder/Non-negligent
manslaughter
0
0
0
0
0
0
0
b.
Negligent manslaughter
0
0
0
0
0
0
0
c.
Sex offenses - Forcible
0
0
0
0
0
0
0
d.
Sex offenses - Non-forcible
0
0
0
0
0
0
0
e.
Robbery
0
0
0
0
0
0
0
f.
Aggravated assault
0
0
0
0
0
0
0
g.
Burglary
0
0
0
0
0
0
0
h.
Motor vehicle theft
0
0
0
0
0
0
0
i.
Arson
0
0
0
0
0
0
0
j.
Simple Assault
0
0
0
0
0
0
0
k.
Larceny-theft
0
0
0
0
0
0
0
l.
Intimidation
0
0
0
0
0
0
0
m.
Destruction/damage/vandalism of
property
0
0
0
0
0
0
0
Category of Bias for Crimes Reported in 2015
Hate Crimes - Public Property (2015)
Total Race Religion
Sexual
Gender Disability
Orientation
Ethnicity /
National
origin
a.
Murder/Non-negligent
Manslaughter
0
0
0
0
0
0
0
b.
Negligent manslaughter
0
0
0
0
0
0
0
c.
Sex offenses - Forcible
0
0
0
0
0
0
0
d.
Sex offenses - Non-forcible
0
0
0
0
0
0
0
e.
Robbery
0
0
0
0
0
0
0
f.
Aggravated assault
0
0
0
0
0
0
0
g.
Burglary
0
0
0
0
0
0
0
h.
Motor vehicle theft
0
0
0
0
0
0
0
i.
Arson
0
0
0
0
0
0
0
j.
Simple Assault
0
0
0
0
0
0
0
k.
Larceny-theft
0
0
0
0
0
0
0
l.
Intimidation
0
0
0
0
0
0
0
m.
Destruction/damage/vandalism of
property
0
0
0
0
0
0
0
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
Agree
Disagree
Strongly
Disagree
No
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
Agree
Disagree
Strongly
Disagree
No
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
Agree
Disagree
Strongly
Disagree
No
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 Carpoolerparking 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
rd
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
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
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
1
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
C
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.
Me
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
.
C
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
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
OR
hours
Minus Used Sick Leave days
OR
hours
Total Sick Leave Being Transferred days
OR
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