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 and  SBC Blue Cross Blue Shield Enrollment Plan and SBC
BCBS Claim Form BCBS Claim Form
MVP Member Enrollment Form and SBC MVP Enrollment Form and SBC
MVP Medco Mail Order Form CSEA Guardian Enrollment Form (Dental)
CDPHP Member Enrollment Form and SBC Guardian Dependent Eligibility Form
CDPHP Medical Claim Form CSEA Flex Spending Health Form
CDPHP RX Mail Order Claim Form CSEA Flex Spending Reimbursement Form
CDPHP RX Claim Form CSEA Flex Spending Dependent Form
JJ Stanis Booklet  
JJ Stanis Dental Claim Form  
JJ Stanis Dental Enrollment Card  
JJ Stanis Life Enrollment Card  
FSA Enrollment  
FSA Claim Reimbursement Request  
BC/BS Benefits Summary  

 

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
Voluntary Salary Reduction Agreement Voluntary Salary Reduction Agreement
Professional Book Reimbursement Request Credit Free Tuition Waiver Form
Retirement Election Form Larraine Springsteen Support Staff
Scholarship Form, Fall 2013
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
Health Insurance Buy-out Part Time Address Change/Name Change Form
Parking Permit Form 2014-15 Holiday Schedule
Voluntary Affirmative Action
Self Identification Form
DCC Employee Assistance Program 
Travel Request and Requisition Form  
In-Service Training Authorization Form  
Address Change/Name Change Form  
2014-15 Holiday Schedule  
DCC Employee Assistance Program  

 

NEW HIRE FACULTY/ADMINISTRATION FORMS
I-9 Form IT-2104 NY State Tax Withholding (2014)
Voluntary Affirmative Action
Self Identification Form
Summary of Fringe Benefits
Direct Deposit Retirement Election Form
Information Security Standards TIAA-CREF Retirement Plan Application/ORP
Code of Ethics NYS Teachers Retirement Application
SUNYCard Authorization Form NYS ERS Application Form
Parking Permit Form TIAA-CREF Voluntary Savings Plan Application
Form W4 (2014) Voluntary Salary Reduction Agreement

 

NEW HIRE CIVIL SERVICE FORMS
Voluntary Affirmative Action
Self Identification Form
Background Check
Code of Ethics Direct Deposit
I-9 Form Information Security Standards
IT-2104 NY State Tax Withholding (2014) SUNYCard Authorization Form
Parking Permit Form Form W4 (2014)
TIAA-CREF Voluntary Savings Application Employee Retirement System Application

 

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  
Professional Employment Application