Forms

Dutchess Community College is committed to the principle of diversity and encourages applications from women, minorities, veterans, the disabled and all others (AA/EOE).

General Forms

ADA Medical Certification Form

ADA Reasonable Accommodation Request Form for Employees

Charge of Discrimination Form

Charge of Sexual Harassment Form

Comp Time Request - NTE

DCC SUNYCard Application Form

Employee Personal Information Form

Outside Compensated Activities Approval Form

Parking Permit Application

Medical and Dental

ADA Medical Certification Form

ADA Reasonable Accommodation Request Form for Employees

CSEA MVP Health Care Benefit Summary Sheet

CSEA NYSHIP Health Care Benefits at a Glance

DEHIC Empire BCBS Claim Form

DEHIC Empire BCBS PPO EPO 20 BVV OE Booklet

Guardian Mobile App

Guardian Anytime Member

Guardian Insurance Plan Summary

Leave of Absence / Time Off Request

Admin-Faculty Time Off Request

CSEA Staff Request for Time Off

Leave of Absence Request Form

Payroll Forms

Address Change / Name Change

Direct Deposit Form

Withholding Certificate Federal W-4

Withholding Certificate NYS IT-2104 Fill-in

Supervisor Forms

Authorization to Commence Recruitment (All employee classification)

In Service Training Authorization

Outside Compensated Activities Approval Form

Payment-Compensatory Request Form

Performance Appraisal Form

Professional Development Report

Recommendation to Appoint (All employee classifications)

Student Employee Payroll Action Form

Supervisors Report of On the Job Injury or Incident

Tuition Reimbursement & Waiver Requests

CSEA Tuition Waiver

DCC Credit-Free Tuition Waiver Form

DCC Tuition Waiver Form

Graduate Tuition Reimbursement (DUE)

Contact Us

Office of Human Resources

Bowne Hall
Monday - Friday, 9 a.m.- 5 p.m.

Phone: (845) 431-8670
Email: officeofhumanresources@sunydutchess.edu

53 Pendell Road
Poughkeepsie, NY 12601

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