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Number	Title
HR-1040	Certificated Request to Return From Leave (Administrative)
HR-1069	Request for Change in Employee's Pay Status (from annualized to paid-as-worked)
HR-4214	Request for Administrator Assignment Action
HR-6121	Interim Administrator Assignment
HR-9161A	Request to Announce Non school Administrator Vacancy
HR-9161B	Request for Administrator Assignment Action (non-school based)
HR-9161C	Request to Announce School-Based Administrator Vacancy
HR-9161D	Request for School Based Administrator Assignment
HR-9161E	Administrator Position - Learn School Selection
HR-1436	Applicant Roster - Certificated Management Position Opening
HR-6115	Request for Transfer - School Based Administrator
HR-9051	Request for Extra Duty Pay for Administrators

Number	Title	Description
HR-1112	Career Ladder Membership Packet	To join the Career Ladder, please review the program overview in the Membership Packet and complete the included membership quiz. Email the quiz answers to ladder@lausd.net.
HR-4300	Tuition Reimbursement Request	Career Ladder Tuition Reimbursement Request Form. Must be accompanied by official transcripts or signed unofficial transcripts and Academic Advisement Form if cumulative GPA is below 2.75.
HR-4301	CL Scholarship Application	CL Scholarship Application contains a Commitment form to declare a credential goal and a Questionnaire. The complete application is to be submitted along with unofficial transcripts, CBEST test scores to apply.
HR-4303	CL Scholarship Request - July	CL Scholarship Request Form for year-end disbursement in July. The entire form including the Information Update are submitted beginning in July along with unofficial transcripts with final grades for the academic year (July 1-June 30) and any required performance assessment(s). Requests must be received by September 30.
HR-4306	Career Ladder Advisement Form (Tuition Reimbursement)	Advisement form to be completed by participants requesting Tuition Reimbursement with a cumulative GPA below a 2.75. (This is a different form than the Academic Advisement form included with the October CL Scholarship Request packet.)
HR-4307	CBEST Test Reimbursement Request	Reimbursement request form for CBEST test fees. Must be accompanied by copy of CBEST test scores regardless of passing. $40 reimbursement, up to 2 times. PA 1 must be completed.
HR-4308	Test Prep Reimbursement Request	Reimbursement Request form for CBEST, CSET/RICA Test preparation courses. PA 2 must be completed to qualify for any test preparation reimbursements.
HR-4310	PA Instructions	Instructions for completing Performance Assessments for Career Ladder participants pursuing a teaching credential
HR-4311	PA 1	Performance Assessment 1 for all Career Ladder participants
HR-4312	PA 2	Performance Assessment 2 for all Career Ladder participants
HR-4313	PA 3	Performance Assessment 3 for Career Ladder participants pursuing a teaching credential
HR-4314	PA 4	Performance Assessment 4 for Career Ladder participants pursuing a teaching credential
HR-4320	PA Instructions - PPS	Instructions for completing Performance Assessments for Career Ladder participants pursuing a teaching credential
HR-4323	PA 3 - PPS	Performance Assessment 3 for Career Ladder participants pursuing a Pupil Personnel Services credential
HR-4324	PA 4 - PPS	Performance Assessment 4 for Career Ladder participants pursuing a Pupil Personnel Services credential

Number	Title
HR-1007	Board Permit (Authorization to teach a subject at a high school based on university coursework. No fee required)
HR-1219	Occupational Therapist/Physical Therapist Renewal Affidavit
HR-1220	Clear and Professional Credential Renewal Affidavit
HR-1282	Current Contracted Employees Informational Form
HR-1289	Speech and Language Renewal Affidavit
HR-1510	Middle School Authorization (Authorization to teach subject grades 6-8 based on university coursework. No fee required)
HR-1526	Application for Committee on Assignments Authorization (Refer to REF-1708.3)
HR-8641	Autism Option Request (includes HR-1231, Verification of Experience)
HR-8766	Emergency 30 Day Substitute Teaching Permit Affidavit
HR-9024	Conversion Non-Confidential Reference Form (Provisional to University Intern OR University Intern to Probationary Contract)
HR-9034	Conversion Non-Confidential Reference Form (Temporary to Probationary Contract)
HR-9059	Procedures for Teachers Converting to Intern / Probationary Contract Status
HR-9981	Retirement System Option Acknowledgement
ES 372	CALSTRS Retirement System Election

Number	Title
	Additional Hours Application, Teachers
	Employment Application, Aide
	Employment Application, Teacher
	Permit/Credential Form
HR-8384	Request for Personnel Action
PC-5005	Request for Transfer, Aides (Change of Work Location)
HR-8152	Resignation Form and Instructions, Teachers
	Statement of Availability, Teachers (Eligibility List)
HR-6500	Substitute Inadequate Service Report , Teachers and Aides
HR-2501	Substitute Statement of Availability, Aides
HR-2501	Substitute Statement of Availability, Teachers
	Substitute Statement of Availability, Teachers ("C" Basis)
	Transfer Application, Teachers

Number	Title	Description
HR-8404	Authorization for Release and/or Exchange of Medical Information
HR-8424	Authorization to Release Tuberculosis Clearance Information
HR-8457	Certificate of Medical Examination & Tuberculosis Clearance Packet	Verification of TB and health clearance. To be completed by a physician after selected for employment as a teacher or substitute.
HR-8459
HR-8472	Tuberculosis Test Results	Verification of TB clearance for permanent employees.

Number	Forms Title
HR-1024	Evaluation of Instructional Personnel - Initial Planning Sheet
HR-1025	Evaluation of Instructional Personnel - Observation / Conference Sheet
HR-1044	Evaluation of Certificated Management Personnel - Initial Planning Sheet.
HR-1049	Evaluation of Certificated Management Personnel - Observation / Conference Sheet
HR-1072	Evaluation of Service Personnel - Initial Planning Sheet
HR-1073	Evaluation of Service Personnel - Observation / Conference Sheet
HR-6087	Report of Conviction / Pending Criminal Court Cases
HR-8000	Change of Name Affidavit
HR-8040	Change of Name Request - Certification
HR-8101	Employment Verification Request
HR-8105	Applicant Fingerprint Information
	Change of Address Request (Payroll Department Form)

Number	Bulletin Title	Summary
BUL-5334	Performance Evaluation and Professional Development for Certificated Management, Supervisory, and Confidential Personnel	This Policy Bulletin outlines instructions and procedures for evaluating the job performance and the professional development of certificated management, supervisory, and confidential employees.
BUL-5335.1	Performance Evaluation for UTLA Bargaining Unit Personnel	This Policy Bulletin delineates certificated bargaining unit personnel to be evaluated and administrative staff responsible for these evaluations.

Number	Reference Guide Title	Summary
REF-1172.2	Certificated Performance Evaluation System: Roster and Forms	This Reference Guide defines the evaluation process for certificated personnel and to provide instructions and procedures for performance evaluation, utilizing rosters and appropriate forms for certificated employees.

Number	Title	Description
HR-7024	Administrative Transfer Request	To transfer a certificated employee from one location to another. Needs local district superintendent approval.
HR-13676	Categorical Limited Contract	To contract an employee who provides certificated services to schools that are participants in one of the Categorically funded programs.
HR-1065	Certificated Request for Leave of Absence	Request for a leave of absence for specified reasons and period of time.
HR-1038	Certificated Request to Return from Leave	Form to return to work after an approved leave of absence.
HR-8152	Certificated Resignation Form and Instructions
HR-8239	Certification of Health Care Provider	Formal approval from physician, if applicable.
HR-8414	Community Representative Application	For employees who serve in an unclassified position as an advisor or consultant to the District.
	Confidential Separation Questionnaire
HR-7762	Continuous Service Transfer Program 2012-13	Provides teachers with permanent or continuing status who meet certain conditions (refer to MEM-5938.0) eligibility to transfer to another location.
HR-8942	Non-Classroom Waiver Form	To transfer from a location identifying the replacement and staff balance, if applicable.
HR-8938	Non-Routine Payment Request Form
HR-1421	Notice of Outstanding Service of Certificated Employee
HR-8937	Notification of Displacement	Notice to inform a teacher in the event there is an over-teachered condition where there are more qualified teachers than positions at a school / program.
MEM-S-41 (Attachment A)	Off-Track Teacher Available to Substitute Form	Form used to evaluate teachers at a specific location who want to substitute during off-track time.
HR-3167	Professional Expert Application	Allows a school or office to employ a qualified person on a temporary basis for a unique and non-repetitive or specific project.
HR-1070	Reduced Workload Leave Agreement
	Reduced Workload Packet
HR-1765	Request for Auxiliary Teachers
	Request for Changes in Assignments and Salaries / Update to Hiring Freeze	Request for Freeze Exemption: Staffing
HR-1067	Request for Change in Employee's Pay Status	Form used to change pay status from "annualized" to "paid as worked".
HR-1006	Request for Emergency Credential / Permit
HR-9985	Request for Extended Illness Benefit - 10/90 Application
HR-9073	Request for Personnel Action (RPA)	Enables a school or office to budget a position that is not norm generated.
HR-8415	Student Aide Application	To employ a full-time student in an unclassified position part-time.
HR-7761	Teacher Initiated Transfer Application 2012-13	Provides credentialed probationary or permanent teachers who meet certain conditions (refer to MEM-5870.0) eligibility to transfer to another location.
HR-1150	Voluntary Displacement Form	To be used only based on projected forecast at the end of a school year or at norm day when a school is over-teachered in a specific subject area.

Number	Title	Description
HR-1087	Confidential Reference Form	Reference form to be submitted by all applicants not currently employed by LAUSD.
HR-3776	Elementary Coursework Sheet	For non-certificated / licensed elementary school applicants. Used to list courses to qualify for Emergency, Pre-Intern and Intern teaching permits.
HR-2602	Non-Confidential Reference Form	Reference form to be submitted by all applicants who are currently employed by LAUSD in any capacity.
HR-2851	Non-Confidential Reference Form for Psychiatric Social Worker (PSW)	Reference form to be submitted by all PSW applicants who are currently employed by LAUSD in any capacity.
HR-9034	Conversion Non-Confidential Reference Form (KT to Probationary)	Form used to evaluate K-12 teachers employed under a temporary (KT) contract.
	Psychiatric Social Worker Application Packet	Forms for Psychiatric Social Worker applicants
	Pupil Services and Attendance Counselor Application Packet	Forms for PSA Counselor applicants
HR-6087	Report of Conviction / Pending Criminal Court Cases	To be completed by applicants who have pending criminal court cases or have been convicted, fined, placed on probation, or given a suspended sentence regardless or dismissal or expungement.
HR-1088	Report of Evaluation of Less Than Satisfactory Service	To be completed by applicants who have received a less than satisfactory service evaluation
HR-2019	Secondary Coursework Sheet	For non-certificated / licensed secondary school applicants. Used to list courses to qualify for Emergency, Pre-Intern and Intern teaching permits.
HR-1086	Teacher Employment or License Denial Cases	To be completed by applicants who have been denied a previously requested teaching license or have been denied employment due to an adverse action.
503-708	Los Angeles County Schools Employment Authorization for Retirant
HR-2018	Student Teaching Reference Form	Should be sent by the Master/Mentor teacher, please do not give to the applicant.

Visit the Risk Management Website to Acess these forms	Description
	Certificated Request to Return from Leave
	Benefits and Responsibilities of Employee Injured as a Result of an Act of Violence
	Special Physical Injury (Act of Violence Report) to be filled out by Administrator
	Employee Report of Incident or Work Related Injury / Illness On-The-Job
	Alleged Act of Violence / Injury Check List
	Act of Violence
	Supplemental Report of Injury

Number	Title	Description
HR-3134	U-Form - Application for point credit approval or degree differential from an accredited institute of higher learning	Application for salary point credit for coursework completed at accredited colleges and universities subsequent to rating in. May also be used to submit coursework for Multiculture credit and to register a masters and / or doctorate degree(s).
HR-3308	S-Form - Supplemental application for training and experience	Supplemental application for training and experience credit completed prior to rating-in for a new employee who has already submitted the A&B rating-in forms.
HR-3128	M-Form - Application for multicultural credit	Application for verification of completion of the requirements for multicultural study, including previously submitted coursework for which salary point credit has been granted.
HR-3127	NA-Form - Application for point credit approval for proposed study in non-accredited schools including foreign institutions	Application for salary point credit for study completed in non-accredited schools including foreign institutions.
HR-3141	T-Form - Instructions for Education Travel Project	Instructions and pre-approval from for Educational Travel Credit (pre-approval must be obtained to receive salary credit).
HR-APU-CA	CA-Form - Application for Conference/Workshop/Seminar Attendance	Application for submission of conference, workshops, and seminar attendance.
HR-APU-CP	CP-Form - Application for Conference/Workshop Presentation	Application for submission of presentations. All presentations are worth ten (10) hours regardless of length.
HR-APU-CW	CW-Form - Application for College Course Work Approval	Application for submission of Level I & II coursework or any related college coursework.
HR-APU-D	D-Form - Application for Teacher Demonstration	Application for teacher demonstration lessons.
HR-APU-O	O-Form - Application for Observation	Application for teacher classroom and Peer observations.
HR-APU-STEP	Application for Step Advancement	Application for the purpose of Step Advancement on the THR salary table.

Number	Title
HR-1079	Certificated Day-to-Day Substitute Teacher Inadequate Service Report
HR-1081	Certificated Day-to-Day Substitute Teacher Commendation Report
HR-2139	Request for Extended Day-to-Day Substitute Online Form
HR-8938	Non-Routine Payment Request Form
HR-8766	Emergency 30-Day Substitute Teaching Permit Affidavit
MEM-6042.0	K-12 Teacher Summer Substitute Registration
MEM S-41	Off-Track Teacher Available to Substitute Form
MEM-5817.0	District Policy and Procedure for Arranging Substitute Teacher Coverage

Document Title

Vendor Application and Instructions

Conference Attendance Request

Contract Proposal Request 13-14

Travel Expense Claim Form

CA Department of Education NCLB Guidance Document

Number	Bulletin Description
BUL-260.3	Culture, Language and Methodology Requirements for Administrators
BUL-999.7	Acceptable Use Policy (AUP) For District Computer and Network Systems
BUL-2047.0	Hate-Motivated Incidents/Hate Crimes Policy
BUL-3772.2	Injury and Illness Prevention Program Requirements
BUL-4222.0	Military Leave of Absence for Certificated Employees
BUL-4223.1	Jury Service for Certificated Employees including Tchr Assistants (Unit F Represented Only)
BUL-4759.1	Williams/Valenzuela Complaint Procedures
BUL-5688.0	Social Media Policy
BUL-5167.0	Code of Conduct with Students
BUL-5159.1	Uniform Complaint Procedures (UCP)
BUL-5181.1	Internet Safety
BUL-5212.1	Bullying and Hazing Policy

Number	Memorandum Description
MEM-5109.2	Support Provider Program Duties and Responsibilities Verification
MEM-5792.0	Tentative Assignment Dates for 2012-2013
MEM-5844.0	CalSTRS Pre-Retirement Workshop Schedule for Certificated Employees
MEM-5872.0	NCLB: Qualifications for Teachers; Parent Notification Requirements and Right to Know Procedures, Annual Principal Certification Form
MEM-5659.0	Authorization to Teach English Learner (EL) Students
MEM-5727.0	Elementary Differential Rosters, Spring 2012 Master Plan For English Learners
MEM-5728.0	Secondary Differential Rosters, Spring 2012 Master Plan For English Learners