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Applicaton
APPLICATION FOR PART-TIME EMPLOYMENT IN PDF FORMAT (PDF, 79 K)
Requires Adobe Reader, free at www.adobe.com.
Benefits
403B REDUCTION FORM (PDF, 62 K)
Voluntary Tax Sheltered Annuity 403(b) Enrollment and Change Form.
CLASSIFIED BENEFITS SUMMARY (PDF, 184 K)
Summary of benefits for Classified employees.
FACULTY BENEFITS SUMMARY (PDF, 184 K)
Summary of benefits for Academic & Administrative faculty.
NOTICE - PPACA
Required notice in accordance with the requirements of the Patient Protection and Affordable Care Act (PPACA) in preparation for the Health Insurance Marketplace Open Enrollment period which begins October 1, 2013 for coverage beginning on January 1, 2014.
PERS BENEFICIARY DESIGNATION FORM (PDF, 166 K)
Update Public Employees Retirement System beneficiary information.
PERS CHANGE PERSONAL INFORMATION (PDF, 389 K)
Change personal information with Public Employees Retirement System.
STANDARD INSURANCE COMPANY CHANGE FORM (PDF, 73 K)
Beneficiary designation and change form
Claims
DENTAL CLAIM FORM (PDF, 75 K)
For dental claim reimbursement.
MEDICAL/VISION CLAIM FORM (PDF, 82 K)
For state self-funded medical and vision plan claims reimbursement.
PRESCRIPTION CLAIM FORM (PDF, 72 K)
Prescription claim form from Catalyst Rx
Hiring/Compensation
FICA - NEW HIRE (MS Word, 41 K)
Used by departments for hiring new part-time Classified and Letter of Appointment Employees New = hired after 7/1/05 or has not been paid for one year.
FICA ALTERNATIVE ENROLLMENT FOR CONTINUING EMPLOYEES (MS Word, 34 K)
Continuing employee: on NSHE payroll one year prior to their current date of hire. FICA Alternative will be mandatory for new employees hired after July 1, 2005.
FICA ALTERNATIVE PLAN INFORMATION (MS Word, 46 K)
FAQ's regarding the FICA Alternative Plan.
I-9 (PDF, 489 K)
Required for all New Hires. Must be completed and returned to H.R. before employee beings working. ONLY bring pages 7, 8, 9 to HR.
OATH (PDF, 54 K)
Required for all Academic Faculty.
PERSONAL DATA FORM (PDF, 179 K)
Completed by all employees at new hire and some demographic data changes.
PROFESSIONAL NEW HIRE CONTRACT WORKSHEET (MS Word, 24 K)
A contract will not be issued unless a new hire contract worksheet is completed and received by HR.
PROFESSIONAL RECURITMENT AUTHORIZATION (MS Word, 31 K)
Before Human Resources can open a recruitment for a Professional position, the recruitment authorization form must be complete and have all of the approving signatures.
SSA-1945 (MS Word, 30 K)
Explanation and Statement concerning Employment in a job that is not covered by Social Security. Used for Classified and Faculty Employees.
VARIABLE WORKDAY SCHEDULE (MS Word, 264 K)
Classified employees only.
Misc Forms
KEY REQUEST (PDF, 92 K)
Forms will be accepted in HR with original signatures or employee may complete form and e-mail form to signature authority, then the signature authority may forward e-mail to hr_payroll@gwmail.gbcnv.edu.
Payroll
2014 PAY REQUEST SCHEDULE
2014 schedule for submission of pay requests for Letters of Appointment employees, anything submitted after the due date will be processed the following month.
BENEFICIARY FOR UNPAID COMPENSATION (PDF, 87 K)
This form designates a beneficiary for your last paycheck.
CLASSIFIED FURLOUGH FORM JULY 2014 - DECEMBER 2014 (PDF, 44 K)
3 days or 24 hours of furlough must be scheduled for July - December. You can not schedule more that 8 hours in a week (Sunday - Saturday. Questions or concerns please contact Sheri at ext. 2155.
DEBIT CARD INFORMATION
DIRECT DEPOSIT - FLAT AMOUNT - STOP (MS Word, 27 K)
Stop a flat amount that is being deducted from your pay check.
DIRECT DEPOSIT - FLAT AMOUNT (MS Word, 29 K)
To select a flat amount to be taken out of your check and distributed to a different account.
DIRECT DEPOSIT - STOP (MS Word, 27 K)
Stop your current direct deposit.
DIRECT DEPOSIT (MS Word, 29 K)
Faculty/Classified/Student/Hourly employees - Please include a voided check with this request. Deliver to Human Resources.
FURLOUGH LEAVE REQUEST FORM - JANUARY - JUNE 2014 (PDF, 44 K)
3 days or 24 hours of furlough must be scheduled for January - June. You can not schedule more that 8 hours in a week (Sunday - Saturday. Questions or concerns please contact Sheri at ext. 2155.
HOURLY TIMESHEET REVISION 07/13 (MS Excel, 50 K)
Used by Part-time Classified hourly employees, letter of appointment hourly and student workers.
PAY REQUEST
Used for Part-time Instructors, LOA and Overload payments. (DEPARTMENTAL USE ONLY) revised 8/12
REQUEST TO WORK OVERTIME (PDF, 67 K)
This is for department use only. This form is to be completed and approved prior to any overtime/compensatory time being worked.
TIME SHEET SCHEDULE (PDF, 53 K)
Dates that timesheets are due to the Human Resources office.
W-4 (PDF, 113 K)
IRS Federal Tax withholding form. Use mailing address.
Performance
EMPLOYEE APPRAISAL & DEVELOPMENT REPORT (NPD-15)
In order for a supervisor to complete and present a classified employee evaluation, he/she must have received the state approved Employee Appraisal training. If a supervisor has not received this training (as per NRS 284.338) please contact our office at 753-2263 for video training information.
EMPLOYEE APPRAISAL INSTRUCTIONS (PDF, 100 K)
Guidelines to assist you in preparing the NPD-15
WPS - ADDITIONAL ELEMENTS (MS Word, 50 K)
WORK PERFORMANCE STANDARDS (NPD-14) (MS Word, 150 K)
Current work performance standards are used as criteria for evaluating the employee’s performance. These standards are developed together by the supervisor and the employee and approved by the appointing authority. Each employee should have a current set of work performance standards on file, and prior to the annual evaluation these standards should be reviewed and updated as necessary.
WORK PERFORMANCE STANDARDS GUIDELINES (MS Word, 148 K)
Guidelines and requirements to assist you in developing employee Work Performance Standards.
Workers' Compensation
C-1 (PDF, 585 K)
Completed by employee when an injury or occupational disease occurs. Must be submitted within 7 days of the incident.
VOLUNTEER AGREEMENT (PDF, 17 K)
Used when a volunteer Category "B" volunteer is engaged: A category "B" volunteer is a person who performs a volunteer assignment for more than three days or on a recurring basis.
Great Basin College - 1500 College Parkway - Elko, Nevada 89801 - 775.738.8493
A member institution of the Nevada System of Higher Education
Accredited by the Northwest Commission on Colleges and Universities

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