Forms

The purpose of this form is to ensure compliance with LCSC and Idaho State Board of Education (SBOE) professional consulting and conflict of interest /ethical conduct policies. By signing the statement annually, you acknowledge you are responsible and accountable for the information set forth in LCSC Professional Consulting and Additional Workload Policy 3.132, LCSC Code of Ethical Conduct Policy 3.101, and SBOE Conflict of Interest and Ethical Conduct Policy, Section II, Subsection Q.

Professional Consulting / Conflict of Interest Statement

Please visit the new Hiring Process page!

The Family and Medical Leave Act (FMLA) is a federal law which entitles eligible employees to unpaid, job protected leave, under qualifying circumstances, as follows: (1) for a qualifying health condition of the employee or a family member; (2) for the birth or adoption of a child; and (3) for specific purposes to family members of qualifying military service members. Employees may, at their discretion, elect to use accrued vacation leave, sick leave, and/or compensatory balances concurrently while on FMLA leave (as appropriate).

To qualify for FMLA leave, the employee must meet eligibility criteria, must submit a written request, and upon return to work must provide a medical release (as appropriate).

In the event an employee does not request FMLA leave for time off work for a qualifying health condition, LCSC will designate the employee’s absence as FMLA leave (as appropriate).

Division of Human Resources FMLA Policy

FMLA Leave Request (completed by employee)

Telecommuting Application (completed by employee if applicable)

Notice of Eligibility & Right and Responsibilities (completed by employer)

Designation Notice (completed by employer)

Certification of Health Care Provider for Employee

Certification of Health Care Provider for Family Member's Serious Health Condition

For institutional funds, in lieu of completing the MOA on every payment-in-addition, a document that includes the following information may be accepted:

  1. Date of agreement
  2. Employee name
  3. Title for job to be performed
  4. Department
  5. Payment amount
  6. Dates of work to be performed
  7. Date to be paid
  8. Description of service/work performed
  9. Employee Signature and date
  10. Supervisor Signature and date

Please visit the Human Resources Performance Management website. 

For assistance on completing the Personnel Action Form, please see Personnel Action Form Instructions or visit the LC State Training Website.

Personnel Action Form (PA) Instructions

PLEASE NOTE:  To prepare a Personnel Action Form (PA), you must have the full version of Adobe Acrobat Professional.  If you do not have the correct version, contact the IT department at x.2231 for further instructions.

File Name:  Name your file with the priority number of the PA (below), with the highest priority being a 1, last name of the employee, first initial, type, department, and semester (if necessary) (i.e., 1.Mouse, M New hire, BUS, SP25) 

  • New Faculty/Staff:  1.Last name, first initial. New hire, department, SP25 (ex: 2.Mouse, M. New hire, BUS) *NO SPACE BETWEEN 1.and the last name
  • New Adjunct/Irregular Help:  2.Last name, first initial. New hire, department, SP25 (ex: 2.Mouse, M. New hire, BUS, SP25) *NO SPACE BETWEEN 2.and the last name
  • Returning Adjunct/Irregular Help:  3.Last name, first initial. Adjunct, department, SP25 (ex: 3.Mouse, M. Adjunct, BUS, SP25) *NO SPACE BETWEEN 3.and the last name
  • Overload/Payment-in-Addition for Current Employee: 4.Last name, first initial. Overload, department, SP25 (ex: 4.Mouse, M. Overload (or PIA), BUS, SP25) *NO SPACE BETWEEN 4.and the last name

Warrior ID: This can be found by searching the employee's name within Colleague on any screen such as NAE, VENI, etc.

Effective Dates:  The "begin date" and "end date" need to be the actual dates that the service is/was performed.  If completing a PA for a new faculty member starting in the upcoming fiscal year, refer to the Instructional Calendar for start and end dates. 

Check All That Apply:  Please be very careful when completing this section as it provides reporting information used by different departments.

  • New Hire:  Check this box when hiring a new employee who will be receiving benefits and complete #9.  If special notations are to be included on the employment contract (i.e., credit toward timeline for tenure/promotion, degree completion, required certifications, moving expenses, etc.), complete #11.
  • Contingent Upon Grant Funding:  Check this box if the position/payment is funded with grant dollars (accounts beginning with "20").
  • Title Change:  Check this box if the position has a title change and complete #10 with reason.  If existing employee, complete #1 on the CHANGE TO and CHANGE FROM section.
  • Salary Change:  Check this box if the employee has an increase/decrease in salary for their current position from the last approved PA and complete #10 with the reason for the increase/decrease.  If an existing employee, complete #4 on the CHANGE TO and CHANGE FROM section.
  • Budget Code Change:  Check this box if the budget code is changing from the last approved PA and complete #10 with the reason.  If existing employee, complete #8 on the CHANGE TO and CHANGE FROM section.
  • Payment-in-Addition:  Check this box if an employee is being compensated for work (other than teaching an overload or as an adjunct) outside their contract/job description and complete #10 detailing the work to be completed.  A Memorandum of Agreement (MOA) must be completed prior to the work being performed and sent for approval with the PA.
  • Payment-in-Addition/Adjunct Instruction:  Check this box if a PSO or CSO employee is being compensated for teaching adjunct instruction and complete #12 and #13 to provide details.  If the employee is either a professional or classified staff teaching outside of their normal division/department, it is imperative that you get written approval from the employee's supervisor prior to submitting the PA.  PA's that are missing the authorization will not be processed until it is received.  An Adjunct/Overload Employment Agreement must be completed and sent for approval with the PA.
  • Payment-in-Addition/Overload Instruction:  Check this box if the faculty member is being compensated for teaching overload and complete #12 and #13 to provide details.  An Adjunct/Overload Employment Agreement must be completed and sent for approval with the PA.
  • Sabbatical:  Check this box if a faculty member is taking a sabbatical and complete #11 with the dates of the sabbatical.
  • Replacement PA:  Check this box if the PA is to replace a previously approved PA.  Include the date of the previously processed PA.
  • Separation PA:  Check this box if an employee's work is ending and include the last day worked.  This date should agree with the "End Date" in the Effective Dates section unless the employee has made special arrangements with both their supervisor and Human Resources to use "vacation" pay to extend employment for a specified reason.

NEW HIRE or CHANGE TO Column:  This section needs to be completed in its entirety for new hires and changes to positions, salaries, budget codes, etc.  This information is used to implement changes in the payroll system.

  1. Title:  Use the official title of the position held by the employee.  If a permanent employee is teaching as an adjunct, include the official title/adjunct. (i.e., Assistant Professor/Adjunct).
  2. Department:  Use the department/division the employee works for.  If a permanent employee is teaching as an adjunct in another department/division, use that department/division.
  3. FTE (permanent employees only):  The FTE must be accurate.  It is used for budgeting and reporting purposes.  If the FTE is less than 1.00, complete #10 with details (i.e., number of hours per week, number of hours per year).  Also, complete and attach the Schedule of Non-Working Hours.
  4. Salary and/or Hourly Rate:  For faculty and professional staff, indicate the annual salary.  If hired during a contract period, check the box indicating so.  For classified staff and irregular help on benefits, indicate the hourly rate.  For all Payment-in-Additions, indicate the total amount to be paid (not including fringe).
  5. Classification:  Use the drop-down box to choose the appropriate classification.  (i.e., Faculty, Professional, Classified, IH, etc.)
  6. Tenure Status:  Use the drop-down box to choose the appropriate status for Faculty. (i.e., Tenured, Tenure Track, Non-Tenure Track)
  7. Health Benefits:  If the employee is eligible to receive health benefits, check the "Yes" box, if not, check the "No" box.
  8. Budget Code/%:  Complete the 10-digit account number(s) and use only whole percentages.  You may use up to 4 different budget codes, but please be sure that percentages add up to 100%.
  9. New Position:  If the new hire is filling a new position, check the "Yes" box.  If the new hire is replacing a current employee, check the "No" box and provide the name of the last permanent employee who filled the position.  If the individual you are hiring is in a "Classified" position, indicate "Shift Differential Eligibility*" by checking either "Yes" or "No".
  10. Comments (reason for changes, payment-in-addition, etc.):  If a PA is initiated for a title change, fte change, salary change, or budget code change, this section needs to be completed to provide detailed supporting information for the change(s).
  11. Comments/Special Notations for Employment Contract (mandatory field):  If a PA is initiated for a new hire or a sabbatical, this section needs to be completed to provide detailed supporting information that will be included in the employment contract.  Information for new hires might include credit toward a timeline for promotion/tenure status, contingent upon completion of a degree, required certifications, moving expense reimbursement, etc.  Indicate N/A if this section does not apply (classified staff, payment-in-additions, etc.)
  12. Total Class Hours Taught (ACA Hours):  Not required for full-time faculty.  We are required to convert the number of credits taught into the total hours worked.
    • Academic and Career & Technical Programs, adjunct office hours/meeting responsibilities will be determined based on the total amount of credits the employee is teaching.  The preparer will calculate the total hours using the formula as follows:  ((# of credits x 2.25)+office hours) to get a weekly number of hours worked for Affordable Care Act (ACA) reporting.  The weekly number of ACA hours will then be multiplied by the number of weeks in the semester to get the total number of ACA hours for the semester.  The total ACA hours for the semester will then be reported in the State Payroll system dependent upon the number of payments the employee is paid over (i.e., total ACA hours of 156 with 2 equal payments would be reported as 78 hours on each payment). 
    • Workforce Training, provide the number of class hours each employee is teaching.  Then, a multiplier of 1.5 will be used to calculate the total number of ACA hours for each respective class.  The total ACA hours will then be reported in the State Payroll system dependent upon the number of payments the employee is paid over. 
    • Dual Credit and Course Development, provide the number of hours associated with each of these activities.
  13. Payment-in-Addition - Adjunct/Overload Instruction Detail:  Complete the course, section, course title, credits, $/credit, and the #/students information.

SEPARATION or CHANGE FROM Column:  Use this section to report current payroll information that is or will be changing.  Complete only those sections that are or will be changing.  Use this column when an employee is "separating" a position.

Routing/Approval Order:  The preparer of the PA (the person completing the form) will type their email on the "Prepared by email" line and fill in all of the necessary LC State emails for the approval process and send the PA as an attachment to the Coordinator/Dept Head/Director.  In the Subject Line of the email, copy what was used as the PA File Name (i.e., Mouse,M. New hire, BUS, SP25).  Each approver will need to attach their digital signature in the appropriate box and either click the "Disapprove" or "Approve" buttons.  If you do not have a digital signature and need help setting one up, please contact the Budget Office.  PA's are to be routed in the order listed in the Routing/Approval Section of the PA.  Only those PA's indicating grant funding (accounts beginning with "20") need to be routed to the Grants & Contracts Office.

If anyone in the approval routing sequence disapproves the PA, the form will be returned to the Coordinator/Dept Head/Director with the reason for disapproval typed in the text of the email.  If a correction needs to be made, the PA needs to be rerouted through the proper approval order.  Minor changes (i.e., spelling or grammatical) may be made by those approving the PA, otherwise, it needs to be disapproved and rerouted.  A copy of the updated PA will be sent to the Coordinator/Dept Head/Director when the PA is forwarded to the next person in the routing order.

When Human Resources receives the PA and new hire paperwork (including background check and identification for Form I-9), it will be processed according to the information provided in all sections and the completed form will be forwarded to the preparer and Coordinator/Dept Head/Director.

*Shift Differential Eligibility:  Employees are eligible for shift differential when 50% of more of an employee's assigned hours in a work week occur between 6:00 p.m. and 7:00 a.m.  Shift differential compensation shall be paid at a rate of 5%.

This form is used for student and irregular help employees (new hire, hourly rate change, separation, etc).

Information on Irregular Help working hours:

This is used to make changes to Classified Staff classifications due to change in job responsibilities, etc.

Therapy animal handlers must complete the Therapy Animal Agreement form. This form must be signed by the department head or supervisor and returned to the Human Resource Services office at least one week prior to the animal’s arrival on campus.

For more information on the Educational Privilege, refer to Policy 3.130

Refer to the Academic Affairs Important Dates for due dates.

Submit this form along with your itemized receipt to VSP for out-of-network vision reimbursement or visit the Benefits & Claim section on VSP's website to submit a claim.

  • If you prefer to submit your claim via mail, please contact Member Services at 800-877-7195 to obtain a VSP Member Reimbursement Form.

Worker's Compensation Steps

  1. Seek Medical Treatment
    Did your injury require emergency medical treatment?
    • Yes: Seek immediate care at the nearest Emergency Room.
    • No:  Visit a State of Idaho preferred provider (Sterling Urgent Care), or view the full provider list if you are out of town.
  2. Complete Required Forms
  3. Submit Work Release Documentation
    After each medical visit, provide a copy of your work release form to both your supervisor and Human Resources.

For more information, please visit the FAQ's.