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Staff and Business Forms

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175 Hour Professional Development Requirements (PDF document)

175 Hour Professional Development Summary Form (PDF document)

403(b) University Availablility Notice (PDF document)

Bids (excessed items) (PDF document)

Bids (non-collusive) (PDF document)

(Use of) Building and Grounds Permit (Fillable PDF document)

Certificate of Coverage Manual (Empire Blue Cross/Blue Shield) (PDF document)

Coaches Reimbursement (PDF document)

Conference Report (PDF document)

Dental Change Form (PDF document)

Dental Claim Form (PDF document)

Direct Deposit (PDF document)

ERS Loans (PDF document)

ERS Members (PDF document)

Federal Tax Withholding: W-4 (link to IRS Web site)

Food Service Request Form / Cafeteria Catering / Field Trip Food Service Request
    (PDF Format)

NYS Tax Withholding: IT-2104 (PDF format)

2016 Flexible Spending Account Guidebook (PDF document)

Flexible Spending Claim (PDF document)

Flexible Spending Claim (Fillable PDF document)

Flexible Spending Enrollment (PDF document)

Flexible Spending Handbook (PDF document)

FOIL Request (PDF document) (updated Aug. 2013)
For applications and additional inquiries, the Records Access Office can also be contacted via e-mail: recordsmanagement@Libertyk12.org

Health Insurance Claim Form - Blue Cross Blue Shield (PDF document) (updated Nov. 2013)

Healthcare Buyout (PDF document)

Health Insurance Benefit Book (PDF document)

HRA Reimbursement Voucher (LSEA) (PDF document)

In-service Course Credit (PDF document)

Life Insurance Beneficiary Form (PDF document)

Mileage Claim (PDF document)

Nonemployee Voucher (PDF document)

Officials (Sports) Claim Form (PDF document)

OMNI Plan Explanation (PDF document)

OMNI Plan Form (PDF document)

Payroll Calendar (PDF document)

Prescription Drugs (PDF document)

Professional Development Summary Form (PDF document)

Reimbursed Expense Voucher (PDF document)

Stipend for Extracurricular Activity (PDF document)

Transportation Request (PDF document)

TRS Address Change (PDF document)

TRS Application (PDF document)

TRS Beneficiary (PDF document)

TRS Loan (PDF document)

Tutor Time Sheet (PDF document)

Vehicle Request Form (PDF document) (updated Nov. 2014)

Vision Plan Claim (PDF document)

Weekly Timesheet (PDF document)

Weekly Timesheet for Grants (PDF document)

WinCapWeb Information | Employee Self Service instructions

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