Forms Faculty/Staff

Intent to Take Leave Form Use this form if you plan to take an extended leave of absence
Health Examiniation Form Use this form when you get a physical for the DUFSD
Salary Adjustment Form Use this form when you are requesting a Educational Credit Salary Adjustment
Cancer Screening Form for Nurses, Teacher Aides, Monitors, Custodial, Clerical, & Kitchen Employees

Use this form when you take leave for cancer screening

READ SPECIFICS TO THE LEFT!!!

Cancer Screening Form for Administrators, Teachers and Teaching Assistants

Use this form when you take leave for cancer screening

READ SPECIFICS TO THE LEFT!!!

Budget Transfer Form For administrators' use only
Payment Voucher Use to request payment from the DUFSD for items other than payroll(Examples: Reimbursement for mileage, miscellaneous supplies, etc.)
Requires admininstrators' approval
Requisition Form For staff use only
Payroll Payment Voucher Use to request payment for stipends, chaperoning etc.
Authorization for Direct Deposit form Use this form to enroll in direct deposit
W-4 Form

To change your federal withholding amounts.

Omni 403b/457b Omni Link for Information & Forms
WES Classroom Coverage Monitor Use this form to request payment for classroom coverage if you are a Monitor at WES.
WES Classroom Coverage Teacher Aide Use this form to request payment for classroom coverage if you are a Teacher Aide at WES.
WES Classroom Coverage Teaching Assistant  Use this form to request payment for classroom coverage if you are a Teaching Assistant at WES. 
WES Classroom Coverage Teacher  Use this form to request payment for classroom coverage if you are a Teacher at WES. 
DES Classroom Coverage Monitor Use this form to request payment for classroom coverage if you are a Monitor at DES.
DES Classroom Coverage Teacher Aide  Use this form to request payment for classroom coverage if you are a Teacher Aide at DES. 
DES Classroom Coverage Teaching Assistant Use this form to request payment for classroom coverage if you are a Teacher Assistant at DES. 
DES Classroom Coverage Teacher  Use this form to request payment for classroom coverage if you are a Teacher at DES. 
MS Classroom Coverage Monitor Use this form to request payment for classroom coverage if you are a Monitor at the MS. 
MS Classroom Coverage Teacher Aide  Use this form to request payment for classroom coverage if you are a Teacher Aide at the MS. 
MS Classroom Coverage Teaching Assistant  Use this form to request payment for classroom coverage if you are a Teaching Assistant at the MS. 
MS Classroom Coverage Teacher  Use this form to request payment for classroom coverage if you are a Teacher at the MS. 
HS Classroom Coverage Monitor  Use this form to request payment for classroom coverage if you are a Monitor at the HS.  
HS Classroom Coverage Teacher Aide  Use this form to request payment for classroom coverage if you are a Teacher Aide at the HS. 
HS Classroom Coverage Teaching Assistant  Use this form to request payment for classroom coverage if you are a Teaching Assistant at the HS. 
HS Classroom Coverage Teacher  Use this form to request payment for classroom coverage if you are a Teacher at the HS. 
Tutor Time Sheet Use this form when you tutor a student.
Tutor Letter $28

This letter must be completed for non-lesson planning tutoring.

Tutor Letter $38

This letter must be completed for lesson-planning tutoring.

DUFSD Action Plan Template

Administrative Use Only.

Hourly Time Sheet

For hourly employees only.

Instructional Substitute Time Sheet For Instructional Substitutes -  Monitors, Aides, Teaching Assistants and Teachers
Non Instructional Substitute Time Sheet For Non Instructional Substitutes - B&G and Clerical
Year -End Extra Curricular Attendance Form This form must be completed and submitted with any extra-curricular stipend payroll payment vouchers.
ACA - Health Insurance Required Yearly Form This form must be completed yearly during open enrollment period for ACA requirements.
2020 Empire BC/BS Alt PPO Summary of Benefits & Coverage Plan information regarding the Empire BC/BS Alt PPO Health Insurance Plan
2020 Empire BC/BS EPO 20 Summary of Benefits & Coverage Plan information regarding the Empire BC/BS EPO 20 Health Insurance Plan
2020 Empire BC/BS Alt PPO Blue View Vision Summary of Benefits Plan information regarding the Empire BC/BS Alt PPO Blue View Vision Health Insurance Plan
2020 Empire BC/BS EPO 20 Blue View Vision Summary of Benefits Plan information regarding the Empire BC/BS EPO 20 Blue View Vision Health Insurance Plan
New York State Tax Withholding To change your state withholding amounts.
Employee Accident Form Use this form if an employee has an accident on the job.
Sexual Harassment Complaint Form If you believe that you have been subjected to sexual harassment, you are encouraged to complete this form and submit it to either District Sexual Harassment Officer (Donna Basting, District Office or Christopher O'Connor, Middle School Office).
CSEA Non-Instructional Sick Leave Bank Request Form If you are a CSEA Non-Instructional Employee, use this form to request Sick Bank Leave.
Reasonable Accommodation Request Form
The purpose of this form is to assist the District in determining whether, or to what extent, a reasonable accommodation may be required for an employee with a disability to perform one or more essential functions of his/her job safely and effectively.
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