Fillable Hiring Packet - STTHOURLY2017aug

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Hiring Packet - STTHOURLY2017aug

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Welcome!
Short-Term Temporary Employee
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 Human Resources (562) 860-2451 ext. 2284. 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 F-1 student, please bring passport)
☐ 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:
☐ District Application for Temporary Short-Term Hourly
☐ I-9 Employment Eligibility
☐ Oath of Allegiance
☐ W-4 – Click on the link and complete the Employee's Withholding Allowance Certificate
☐ Mailing Warrants Authorization option
☐ Emergency Contact
☐ Warrant Recipient Designation
☐ Retirement Questionnaire
☐ Staff Diversity Questionnaire
☐ Acknowledgement Statements for Short-Term and Student Hourly Employees
☐ Verification of Receipt
Keep the following forms and links for your reference:
AP 3050 Code of Ethics Policy
Nondiscrimination and Sexual Harassment Policy
AP 3518 Child Abuse Reporting Policy
BP 7050 Conflict of Interest Policy
Personal Safety on Campus
Time Card Memo
TB Memo & Referral
Campus Map
Student Health and Wellness Center
Temporary Short-Term Hourly Application
It is necessary to complete this application in full, whether or not a resume is attached.
NAME
Last Name:
First Name:
M.I.
Address:
City:
State & Zip Code:
Business or
message phone:
E-mail address:
ED
UCATION
LEVEL/SCHOOL NAME
CITY/STATE
DEGREE
MAJOR
GRADUATED
High School
Name:
Yes No
College/University
Name:
Yes No
Other
Name:
Yes No
G
ENERAL INFORMATION
Have you ever been employed by Cerritos College?
Yes No If yes, when?
Do you have the legal right to work in the United States?
Yes No
Do you have relatives, by blood or law, who are currently employed by Cerritos College?
Yes No If yes, provide name and department:
Have you ever been arrested for any crime (other than a minor traffic violation) which resulted in a conviction or a plea of nolo contender?
Yes No If yes, contact Human Resources and request the Record of Conviction form.
A conviction will not necessarily disqualify an applicant from employment.
RE
FERENCES: In addition to current or former supervisor, you may list additional work references. Do not include relatives.
NAME
COMPANY
PHONE # OR EMAIL
HIRING SUPERVISOR USE ONLY
REFERENCES CHECKED BY (Name)
FOR DEPARTMENT USE ONLY
Job Class Code
Classification
Short-Term
Substitute
Are you a current Cerritos College student carrying 12 units
12 units or more? Yes No
Cerritos College
11110 Alondra Blvd.
Norwalk, CA 90650
(562) 860-2451
www.cerritos.edu
EMPLOYMENT HISTORY (starting with current or most recent employer)
Starting position:
Salary:
From:
Department:
Last position:
Salary:
To:
Job duties:
Person to
contact:
Address:
Phone:
May we contact this company for employment references? Yes No Type of employment: Full-time Part-time Temporary
Starting position:
Salary:
From:
Department:
Last position:
Salary:
To:
Job duties:
Person to
contact:
Address:
Phone:
May we contact this company for employment references? Yes No Type of employment: Full-time Part-time Temporary
I certify that the information I have provided in applying for this job is true and complete to the best of my knowledge and belief. I give Cerritos College
and its authorized agents permission to verify and/or disclose any information given in connection with this application for personnel/employment
purposes. I acknowledge that any misstatement or omission in the application materials may be cause for elimination from further consideration or
dismissal if hired. I hereby authorize any and all persons and agencies to furnish to Cerritos College any information, including documents in my
personnel file, which may be necessary to verify this application and any other materials submitted, and hereby waive any rights of privacy to the
information or documents which I may have under any federal, state, or local law, ordinance or rule. I also understand that an incomplete application
packet may delay or prevent opportunities with Cerritos College.
Applicant’s Signature:
________________________________________________________ Date: __________________________________________________
Cerritos College is an Equal Opportunity Employer with a commitment to provide equal opportunity for all without regard to race, religion, national origin, sex, age, handicap, medical
condition or Vietnam era veteran status. Cerritos College complies with Title IX Educational Amendment of 1962 prohibiting sex discrimination in education. If you have a disability, and
require accommodation to complete this application, contact the Human Resources office. Cerritos College employs only individuals lawfully authorized to work in the United States. Cerritos
College does not provide sponsorship for changes in immigration status for the purpose of employment in the United States.
HR011910-HRLY
6
Cerritos College
11110
Alondra Blvd.
Norwalk, CA 90650-6298
(562)
860-2451
www.cerritos.edu
Record of Con
viction
Supplemental Employment Application Information
Submit with Application only if Necessary
Because of our responsibility to students and to the public, it is important to be extremely careful in screening applicants with conviction
records. You may be disqualified from consideration for, or dismissed from employment with Cerritos College unless you fill out this form
accurately and completely. In accordance with District policies, procedures, and the provisions of the Education Code, all prospective
employees are fingerprinted and the fingerprints are submitted for verification.
In completing this form, you must include all sex offenses and controlled substance offenses even if they have been set aside by Penal
Code section 1203.4, but you may omit minor traffic infractions. A criminal record will not automatically disqualify you from your
employment, but failure to list all convictions may result in disqualification or dismissal.
INSTRUCTIONS: In the space below, give complete details for every time you have pled guilty, been convicted, fined, imprisoned, placed
on probation, or given a suspended sentence in court. Please indicate if the situation was a misdemeanor or felony offense. If you are in
doubt, list the conviction and explain. Do not include minor traffic infractions where the fine was $300 or less. For additional space, use a
separate sheet.
Offense
(Brief Description)
Offense
Code No.
(if known)
Date
Mo/Yr
Location
(City & State)
Disposition (imprisonment, fine,
probation, suspended sentence) Misd* Flny*
* Misd = Misdemeanor Flny = Felony
A
re you currently out on bail or released on your own recognizance pending
trial regarding a criminal matter?
No Yes (please complete information below)
INST
RUCTIONS: In the space below, give complete details regarding the criminal matter(s) for which you are currently out on bail or
released on your own recognizance. For additional space, use a separate sheet.
Offense
(Brief Description)
Offense
Code No.
(if known)
Date
Mo/Yr
Location
(City & State)
Disposition (imprisonment, fine,
probation, suspended sentence) Misd* Flny*
* Misd = Misdemeanor Flny = Felony
DEC
LARATION: I declare under penalty of perjury under the laws of the State of California that the information listed above is true and
complete.
Applicant’s Signature: _____________________________________________________________ Date: _______________________________________
 PLEASE NOTE 
IF YOU ANSWERED YES TO THE QUESTION: Have you ever been
convicted of a criminal offense? complete and submit this form
with your application package, OTHERWISE, DO NOT SUBMIT IT
.
Last Name First Name Middle Position applied for:
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
PRE-EMPLOYMENT CLEARANCE REQUIREMENTS
SHORT-TERM TEMPORARY HOURLY EMPLOYEE
I hereby acknowledge that I understand that I must comply with all requirements for clearance for employment with the
District before I am authorized to render any service as an employee. I also understand that once cleared for service that
such employment is on a temporary, as needed basis.
I understand that I must comply with all of the following requirements in order to be authorized to begin employment.
1. Complete the Employment Eligibility Verification (Form I-9) and present the required identification and employment
eligibility documents to verify authorization to work.
2. Complete all required District personnel/payroll employment forms.
3. Submit verification of a current negative tuberculin skin test or chest X-ray report.
4. Any other requirements for employment as may be specified by the Office of Human Resources.
I further understand that if I render any service to the District without complying with the above requirements such
service shall not be considered as approved employment by the District or qualify for any compensation.
Name of Employee
Signature
Date
ACKNOWLEDGEMENT STATEMENT FOR STUDENT EMPLOYMENT
I hereby acknowledge my understanding of the following regulations for temporary part-time student employment at
the Cerritos Community College District:
1. In order to be eligible for student employment, I must be actively enrolled in a minimum of twelve (12) semester units
of coursework of which at least six (6) semester units are courses at Cerritos College, and the remaining units required
(to total at least 12) must also include coursework at another institution(s).
2. The above requirement for enrollment in coursework applied to both the Fall and Spring semesters of each academic
year.
3. I must provide appropriate written verification of enrollment in any coursework from other institution(s) being used
to meet the 12 semester unit requirement as indicated in item #1 above.
4. I must immediately notify my supervisor if at any time I cease to be actively enrolled in the minimum coursework
required for student employment indicated in item #1 above.
5. Student employment is on a temporary part-time hourly “as needed” basis, and a student employee cannot work
more than a total of twenty (20) hours per week (all student employment service combined).
Name of Employee
Signature
Date
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
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
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
6/91
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
11/12
CERRITOS COMMUNITY COLLEGE DISTRICT
11110 Alondra Blvd. Norwalk, CA 90650
QUESTIONNAIRE FOR NON-ACADEMIC EMPLOYEES WHO ARE NEW TO THIS DISTRICT
Last Name ____________________________ First Name _______________________ MI _______
Street Address _______________________________ City ______________________ Zip _________
Date of Birth ___________________ Telephone _____________________ Student ID ____________
Employment Status
___ Classified ___ Short Term Temporary Hourly
___ Management ___ Federal Work Study
Have you ever worked in another school district? ________
If yes, which one? _________________________________________ When? _____________________
Retirement Status
1. Are you a member of the California Public Employees’ Retirement System (PERS)? Yes No
Have you ever withdrawn these funds? ______ If yes, date of withdrawal __________________
Have you re-deposited these funds? ______ When? __________________
Are you contributing into the Public Employees’ Retirement System in any other state or governmental
agency? _____ Full-time or Part-time ___________ if so, where? ____________________________
What was the effective date of your membership into the system? __________________
2.
Are you a member of the State Teachers’ Retirement System (STRS)? Yes No
Have you ever withdrawn these funds? ______ If yes, date of withdrawal __________________
Have you re-deposited these funds? ______ When? __________________
Are you contributing into the State Teachers’ Retirement System in any other state or governmental
agency? _____ Full-time or Part-time ___________ if so, where? ____________________________
What was the effective date of your membership into the system? __________________
Are you employed in any other district during this school year? _______ If so, list:
County
District
Regular
% of Full-Time
Sub
Hourly
(Continued on Reverse)
CERRITOS COMMUNITY COLLEGE DISTRICT
11110 Alondra Blvd. Norwalk, CA 90650
NON-CERTIFICATED EMPLOYEES PERS REGULATIONS REQUIRING MEMBERSHIP.
PLEASE READ CAREFULLY.
1. Student Hourly employees are excluded from membership in PERS
2. Persons who have funds on deposit with PERS cannot be excluded from membership regardless of the
type of appointment, permanent or temporary, at the time of employment.
3. Classified Employees become members of PERS on the first day of employment if the position
requires service for at least an average of 20 hours per week.
Part-Time Classified Employees become members from the first day of employment if the position
requires service for at least an average of 20 hours per week.
4. Temporary full-time employees employed for a specific duration (more than six months), become
members on the first day of employment. If length of employment is for less than six months, but
employment is subsequent extended past six months, the individual is excluded from PERS membership
for only the first six months of services. Membership is effective not later than the first day of the
seventh month of employment.
5. Regular Classified Hourly employees and Temporary Adult Hourly or Substitute Hourly employees
employed on an irregular or “as needed” basis become members only if they work 1,000 hours or 125
days within one fiscal year. Membership will be effective on the first day of the month following the
month in which the 1,000 hours of 125 days of service were completed.
QUALIFYING EMPLOYEES WHO BECOME MEMBERS IN PERS MUST ALSO PARTICIPATE
AND CONTRIBUTE IN THE SOCIAL SECURITY SYSTEM.
ACCEPTANCE OF EMPLOYMENT IN A POSITION REQUIRING MEMBERSHIP IN THE SYSTEM IS
YOUR CONSENT TO HAVE DEDUCTIONS FROM SALARY TAKEN FOR PERS AND SOCIAL
SECURITY SYSTEM.
Signature
Date
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
Verification of Receipt of New Employee Information
(Short-Term Temporary Hourly Employees)
Y:Beryl_Donna/Processing Forms for New Hires/Receipt New Classified 2014 2014
I hereby certify that I have received the following items from the Human Resources office as
part of my new employment processing:
AP 3050 Institutional Code of Ethics
AP 3518 Child Abuse & Neglect Reporting
BP 7050 Conflict of Interest Notice
Campus Map
Non-Discrimination Policy & Procedures Brochure
Personal Safety on Campus Brochure
Student Health & Wellness Center Brochure
Tuberculin Test Memorandum
Employee Name (Print)
Signature of Employee
Date
Signature of Human Resources Office
Date
CERRITOS COMMUNITY COLLEGE
TO: SHORT-TERM/SUBSTITUTE AND STUDENT EMPLOYEES
FROM: PAYROLL OFFICE
SUBJECT: TIME CARDS
The following information will explain the procedures to be followed so that
Payroll Office may serve you more efficiently.
1. Time cards are color coded: Use WHITE unless you are working under the Federal Work Study Program (orange)
or other Federal Programs (blue or buff), see Supervisor.
2. Print your full legal name and effective pay period at the top of both sides of timecard. NO NICKNAMES.
3. Timecards must be completed in ink or typed (no pencil). Employee SIGNATURE and SOCIAL SECURITY
NUMBER are required. Turn card into your supervisor/manager for signature.
4. Pay Periods begin the 25
th
of the month and end on the 24
th
. Example: January 25
th
– February 24
th
)
5. Deadline for cards to be turned into the Payroll Office is no later than the second working day after the 24
th
.
6. Record the date, time in, time out, and EXTEND the hours.
7. Record the description of your work or the title you were hired under in the proper column.
8. TOTAL HOURS WORKED
9. If working for more than one supervisor and turning in more than one time card, watch carefully that you do
not overlap hours on the same day.
10. A 30-minute lunch/break must be recorded if you are working over 6 hours consecutively.
11. Working in excess of 8 hours in a day and/or 40 hours in a week is overtime. Overtime must be pre-approved
by your manager. An overtime approval slip signed by the manager is required and attached to the back of the
timecard.
12. Payday is the 10
th
of each month after 11:00am. When the 10
th
falls on a Saturday/Sunday/Holiday, payday
will be on the Friday preceding.
13. Identification is required when picking up your check. Bring your ASCC ID Card or Driver’s License with you.
14. If you are under the Federal Work-Study Program (Orange timecard), turn your timecard into the Financial
Aid Office.
15. Payroll/Fee Station window is open Monday through Friday, 8:00am – 4:30pm
FAILURE TO COMPLY WITH THESE PROCEDURES COULD DELAY THE ISSUANCE OF YOUR PAYCHECK.
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Hiring Packet - STTHOURLY2017aug

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Completed 17 February 2020

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