Checklist and Approval for Hiring Non-DistrictPart-Time Employees

After School Programs, Summer Enrichment, Adult & Community Education,

Coaching Staff, Home-based and Homebound Teachers

Section A

has been recommended for the positionof

at beginning in the 2017-2018school year. Start Date:

Please check one of the following and submit the required information/documentation

A.New DCSD Employee—Application packet must include:

  1. Completed Sections A and B of “Checklist and Approval for Hiring Non-District/Part-Time Employees” form
  2. Completed application form
  3. NEW HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS NOTICE
  4. Completed and signed Form I-9 and acceptable ID(s) as specified on page 2 of Form I-9
  5. Copy of social security card
  6. Copy of driver license
  7. Complete list of references; in addition, the application packet contains three reference forms which must be completed and sent by the reference directly to the Department of Human Resources
  8. Emergency Information Form
  9. Corporal Punishment Policy
  10. Completed and signed Student Welfare Policy – Abuse/Neglect Reporting Requirements
  11. Drug Abuse Policy Statement (employee retains for reference)
  12. Sexual Harassment Policy (employee retains for reference)
  13. Employee Acknowledgment of Risk Management Training (employee retains one copy for reference)
  14. Signed 403(b) Plan Initial Notification (employee retains one copy for reference)
  15. Signed SC Retirement System Optional Membership Form
  16. Authorization Agreement for Direct Deposit (optional)
  17. Completed and signed W-4
  18. Copy of teaching certification, if applicable
  19. TB (Tuberculosis) Skin Test
  20. One of the following:

Retirement Plan Enrollment (Form 1100) and Active Member Beneficiary Form (Form 1102)

or Election of Non-Membership (Form 1104)

or Notification of Employed Retiree (Form 1114)

B.Returning/Current DCSD Employee*(*if inactive in payroll system, please refer to “A” above)— if active in payroll system, application packet must only include:

1.Completed Sections A and B of this form with the following approval signatures

2.Any W-4 or retirement forms employee wishes to have updated in payroll system

3.Social Security number of employee - -

C. Retired Employee Previously Enrolled in Any SC State Retirement System(*if inactive in payroll system, please refer to “A” above)— if active in payroll system, application packet must only include:

1.CompletedSections A and B of this form with the following approval signatures

2.Any W-4 or retirement forms employee wishes to have updated in payroll system

3.Completed Form 1114, “Notification of Retired Employee”

Section B CHCH

PLEASE ROUTE:

1.

Principal/Department Head SignatureDate

Principal/Department Headthen forwardscompletedpacket to Department of Human Resources

2.

Assistant Superintendent of Human Resources ApprovalDate

Department of Human Resources signs/dates andsends packet to Administrator/Supervisor

3.

Administrator/Supervisor ApprovalDate

Administrator/Supervisorsigns, dates, and delivers original payroll formsto Finance and retains a copy.

Budget Account #: --- Revised:01/12/2017

CHARGE SLED CHECK to Account #______-______-______-______