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 SBC Blue Cross Blue Shield Enrollment Plan and SBC
MVP Member Enrollment Form and SBC Empire BCBS Claim Form
MVP Medco Mail Order Form MVP Enrollment Form and SBC
CDPHP Member Enrollment Form and SBC CSEA Guardian Enrollment Form (Dental)
CDPHP Medical Claim Form Guardian Dependent Eligibility Form
CDPHP RX Mail Order Claim Form CSEA Flex Spending Health Form
CDPHP RX Claim Form CSEA Flex Spending Reimbursement Form
JJ Stanis Booklet CSEA Flex Spending Dependent Form
JJ Stanis Dental Claim Form  
FSA Enrollment  
FSA Claim Reimbursement Request  
BC/BS 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  
Health Insurance Buy-out Part Time  
Parking Permit Form  
Voluntary Affirmative Action
Self Identification Form
 
Travel Request and Requisition Form  

 

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