The following forms must accompany each "Intent to Employ" for new student help and federal work-study employees, unless otherwise noted.

• Student Employee Intent to Employ Form P-103C (PDF)
• A signed and dated copy of the Compliance Checklist (PDF). Provide the employee with a copy to keep for their records. By signing, the employee acknowledges receipt of the following information:
  1. New Employee Training Checklist P-202 (PDF)
     Ask employee to complete the entire form. Give employee the information attached to the form. Make sure that the person who explains this form to the employee signs and dates the bottom of this form in the "Hiring Representative Signature" field. Make sure to give the employee a copy of the appropriate job safety analysis ( see all job safety analyses).
  2. Workers' Compensation Packet (PDF) and Facts about Workers' Compensation (PDF)
     Includes information and optional pre-designation form. By signing, employee acknowledges their receipt of the additional Workers' Compensation information. Make sure that the hiring manager/representative also signs this form.
  3. Statement Concerning Your Employment in a Job Not Covered by Social Security Form SSA-1945 (PDF)
  4. Notice of Exclusion from CalPERS Membership – Student (PDF)
     This form must be re-submitted each time the employee has a break in service.
  5. Employee FERPA Agreement Form S-1 (PDF)
  6. Hepatitis B Information (PDF)
     This includes the link to the Vaccination Acceptance/Declination Form GS-178, a list of positions that require the Hepatitis B form/training, and training instructions.
  7. Mandatory Title IX Not Anymore Training Memo (PDF)
     Los Rios requires that every new employee complete Title IX Mandatory Training on Violence Intervention & Prevention (also called Not Anymore training) within 30 days of their hire date. The training can be taken through Employee Self-Service.
  8. Policy P-8631: Conflict of Interest Rules (PDF)
  9. Computer Use Regulations: R-8811: Purpose and Definitions (PDF); R-8831: Statement of Rights and Responsibilities (PDF); R-8851: Privacy and Confidentiality (PDF); R-8871: Information Security (PDF)
  10. Annual Rights and Responsibilities Memo (PDF)
  11. Employee Self-Service Information Form P-195 (PDF)
      Ask the employee to go online and follow the instructions. If the employee cannot complete the information online, then they can submit the included form. The form is not required if the employee completes the information online. If the form is submitted separately from the Intent to Employe, it should be sent to "DO/HR, Attn: Alert".
  12. Health Insurance Marketplace Notice to New Hires (PDF)
  13. Paid Sick Leave – Notice to Employees (PDF)
  14. Employment Development Department Booklet (PDF)
      By signing the "Compliance Checklist" form, employee acknowledges they have been informed that the district is in compliance with the Americans with Disabilities Act (ADA) and they have been given the attached brochure from the Employment Development Department (EDD) regarding State Unemployment Insurance. Please note: The district does not participate in State Disability Insurance because the district has their own disability plan.
  15. 403(b) Tax Sheltered Annuity (TSA) Plan information. Call or email Employee Benefits at (916) 568-3070 or benefits@losrios.edu – or visit Envoy Plan Services – for more information.
• Victims of Domestic Violence Leave Notice (PDF)
• Demographic Survey (PDF)
  This information is kept confidential (collected for reporting purposes only)
• Employment Eligibility Disclosure Form P-150 (PDF)
  Mandatory for all employees being fingerprinted and Report of Convictions P-881 (PDF) (if applicable)
• I-9 Employment Eligibility Verification Form
  This form is required by law. Photo copies of the employees documents used to complete the I-9 must accompany the completed form. Please follow the instructions on the form or visit US Citizenship and Immigration Services website for the Handbook for Employees for more directions and examples of acceptable documentation.
  Note: This form is a secure document and may not automatically open. You may see the words "Please wait." If the form does not open, then you will have to download and save the document in order to fill it out.
• Fingerprint – Live Scan Receipt and Payroll Deduction Form. Fingerprint packet is available through the supervisor or the campus Business Office.
• Oath of Allegiance (PDF)
• Social Security Card – photo copy required for IRS purposes
• Federal Withholding Allowance Certificate Form W-4 (PDF)
• California State Withholding Allowance Certificate Form DE-4 (PDF)
  This form is optional. If a DE-4 form is not submitted, then state withholding will be identical to the federal withholding indicated on the W-4 (federal withholding form).
• Policy P-2631: Student Employment (PDF) and Regulation R-2631: Student Employment (PDF)
• Direct Deposit Form BS-178 (PDF)
• The following Child Abuse Mandated Reporter Information:
  • Mandated Reporter Statement Form P-155 (PDF)
  • Reporting Tips (PDF)
  • Mandated Reporter Guidebook (PDF)
  • Suspected Child Abuse Report Form (PDF)
  • California Department of Social Services Mandated Reporter Information →