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).

 

Applications for employment:

Dutchess County Application

Dutchess Community College Application

MEDICAL FORMS
PROFESSIONAL STAFF	CIVIL SERVICE STAFF
Empire Blue Cross/Blue Shield Enrollment Form / SBC HA PPO / SBC EPO	Blue Cross Blue Shield Enrollment Plan and SBC
BCBS Claim Form	BCBS Claim Form
JJ Stanis Booklet	CSEA Guardian Enrollment Form (Dental)
JJ Stanis Dental Claim Form	Guardian Dependent Eligibility Form
JJ Stanis Dental Enrollment Card	FSA Enrollment
JJ Stanis Life Enrollment Card
FSA Enrollment
Adjuncts FSA Enrollment
FSA Claim Reimbursement Request
BC/BS Benefits Summary Comparison
Administrator and Faculty Health Insurance Rates
Standard Life - Long-Term Disability

 

GENERAL EMPLOYEE FORMS
PROFESSIONAL STAFF	CIVIL SERVICE STAFF
Administrative Staff Request for Time Off	CSEA Staff Request for Time Off
Leave of Absence Form	Leave of Absence Form
NYS Deferred Compensation Plan	NYS Deferred Compensation Plan
Professional Book Reimbursement Request	Credit Free Tuition Waiver Form
Retirement Election Form	Voluntary Retirement Savings Instructions
Credit Free Tuition Waiver Form	Tuition Waiver Form
Tuition Waiver Form	Parking Permit Form
Health Insurance Buy-out Full Time	In-Service Training Authorization Form
Parking Permit Form	Address Change/Name Change Form
Voluntary Affirmative Action  Self Identification Form	2018-19 Holiday Schedule
Voluntary Retirement Savings Instructions	DCC Employee Assistance Program
In-Service Training Authorization Form
Address Change/Name Change Form
2018-19 Holiday Schedule
DCC Employee Assistance Program
Non-Teaching Educator Comp Request Form
Kronos Comp Time Entry for  Non-Teaching Educators
Administrator Workday Teaching Activity Approval Form
Eligibility Memo

 

NEW HIRE FACULTY/ADMINISTRATION FORMS
I-9 Form I-9 Form Instruction Booklet	IT-2104 NY State Tax Withholding (2018)
Voluntary Affirmative Action Self Identification Form	Summary of Fringe Benefits
Direct Deposit	Retirement Election Form
Information Security Standards	Voluntary Retirement Savings Instructions
Code of Ethics	NYS Teachers Retirement Application
SUNYCard Authorization Form	NYS ERS Application Form
Parking Permit Form	Designation of Beneficiary
Form W4 (2018)

 

NEW HIRE CIVIL SERVICE FORMS
Voluntary Affirmative Action Self Identification Form	Background Check
Code of Ethics	Direct Deposit
I-9 Form I-9 Form Instruction Booklet	Information Security Standards
IT-2104 NY State Tax Withholding (2018)	SUNYCard Authorization Form
Parking Permit Form	Form W4 (2018)
Voluntary Retirement Savings Instructions	CSEA Vision Enrollment Form
Designation of Beneficiary

 

SUPERVISORY FORMS
PROFESSIONAL STAFF	CIVIL SERVICE STAFF
Professional Development Report	Civil Service Performance and Work Appraisal Form
Interview Form	Interview Form
Telephone Reference Questionnaire	Telephone Reference Questionnaire
Faculty Appointment	Dutchess County Application
Faculty Recruitment	Civil Service Recruitment
Administrative Appointment	Civil Service Appointment
Administrative Recruitment	Payment Compensatory Request Form
Professional Employment Application
Payment Compensatory Request Form

 

SUPERVISOR OF STUDENT EMPLOYEES
Student Employee Payroll Action Form	Student Worker Evaluation Form
Student Worker Reference Questionnaire