FORMS/DOCUMENTS

BUSD Benefits Dept

Employee Assistance Program

Employee Assistance Program

2024 Rate Sheets

2024 Adult school Contribution Rate Sheet

2024 BCCE Contribution Rate Sheets

2024 BFT Contribution Rate Sheets

2024 Local 21 Contribution Rate Sheets

2024 Non-Represented Certificated Contribution Rate Sheets

2024 Non-Represented Classified Contribution Rate Sheets

2024 Early Childhood Education Contribution Rate Sheets

2024 UBA Contribution Rate Sheets

Fillable Benefit Forms

 Lincoln Beneficiary Form

 Lincoln Change Request Form

 Lincoln Change Request Form

 Lincoln Enrollment Form

 Lincoln EOI Instruction

 Lincoln Adjustment Report

 Delta Dental Dual Choice Fillable Form

 VSP Enrollment & Change Form Fillable

 BASIC Pacific FSA Enrollment Form Fillable

 BASIC Pacific P&T Enrollment Change Form Fillable

 BASIC Pacific Mid-Year change form

 CalPERS Health Benefits Enrollment Form (HBD-12)

 CalPERS Affidavit of Marriage/Domestic Partnership Form

 CalPERS Medical Report for Disabled Dependents

 CalPERS Questionnaire for Disabled Dependents

 CalPERS COBRA continuation of Coverage Form

 CalPERS COBRA Continuation of Coverage Retiree

 Lincoln Financial Evidence of Insurability (EOI) Form

 Lincoln Voluntary Term Life Employee Enrollment Form

 Lincoln Voluntary Term Life Employee Enrollment Form – Fillable

 Cash in Lieu Form

 Domestic Partnership Application/Affidavit

Debit Cards for FSA & Transit Accounts (BASIC pacific)

Dependent Care

Commuter Accounts

FSA

MyCash Account

BUSD Employee Forms and Information

Mandated Reporting of Suspected Child Abuse

Suspected Child Abuse Reporting Form

Suspected Child Abuse Reporting Instructions

Elder Abuse Reporting Form

Sexual Harassment Policy and Reporting Procedures

BUSD Sexual Harassment Policy, complaint form, and additional resources.

Employment Forms

Certificated Inservice Hours – IEP & SST

Certificated Inservice Hours – Non IEP/SST

Certificated – Transcript Submission Evaluation or Balance Inquiry Request

Change of Address, Telephone or Name Form

Designation of Beneficiary

Emergency Contact Information

Leave Request 21-22, All Employees

Certificated Leave Request Form

Classified Leave Request Form

NCLB Certificate of Compliance

Personnel Status Change Form

Professional Growth Policies & Procedures

Reasonable Accommodations

Request for Course Approval

Request for Information from Medical Provider

Request for Paid Sick Leave for Substitute Employees

Separation from BUSD Form

Classified Verification of Work Experience & Sick Leave Balance 

Certificated Verification of of Experience and Sick Leave Transfer Forms

Substitute Medical Stipend Application

Vacation Leave Request Form

BUSD Human Resources Dept

For Employment Verifications and Personnel file reviews please contact HR@Berkeley.net

Escape Employee Online Portal (EOP)

Frontline Absence Management

Open Classified Positions

Classified Job Descriptions(ALL)

Employee Handbook 2019-20

Substitute Teachers’ Handbook 2023-24

Holiday Calendar for 2023-24

Holiday Calendar for 2024-25

Teacher Induction Program (TIP)

Human Resources and Personnel Commission Organizational Chart

Union Contracts, Calendars and Salary Schedules

BUSD Payroll Dept

2023-2024 Pay Dates

2023-2024 Holiday Calendar

2024-2025 Pay Dates

2024-2025 Holiday Calendar

Direct Deposit Form

Request to Cancel Direct Deposit

2024 W-4 Form

IRS W4 withholding estimator

DE4 State Withholding Form

E-Timesheets

E-Timesheets Instructions

Classified E-Timesheet

Employee Information – EOP

Escape Employee Online Portal (EOP)

Retirement

CalPERS Online

CalSTRS Online

Tax Sheltered Annuities (TSA’s)

Meaningful Notice / Plan Summary Information 2022

403b and 457 Plan Approved Vendors

BUSD Risk Management Dept

If you are injured at work…READ THIS

Risk Management Downloadable Forms

Confidential School Incident Report

Request for Proof of Insurance (for Field Trips, etc.)

Report of Hazard   [RM-01]

Safety Suggestion Form

Claim for Damages

School Parade Guidelines

School Parade Guidelines for Participants

Student Injury Claim Reporting Procedures, Instructions and Form – English

Student Injury Claim Form – Spanish

Student Accident and Sickness Insurance

Accidente Estudiantil y Seguro de Enfermedad 

Workers’ Compensation Downloadable Forms

Report of Incident [RM-03]

Witness Statement [RM-04]

Supervisor’s Report of Investigation [RM-05]

Workers’ Compensation Claim Form [DWC-1]

Acknowledgement of Receipt

Notice to Employees [DWC-7]

Aviso a los Empleados [DWC-7]

BUSD Workers’ Compensation Policy

TargetSolutions Online Training

TargetSolutions Online Training