| 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!!!
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| Cancer Screening Form for Administrators, Teachers and Teaching Assistants |
Use this form when you take leave for cancer screening
READ SPECIFICS TO THE LEFT!!!
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| 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.
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| Omni 403b/457b |
Omni Link for Information & Forms |
| Classroom Coverage Request for Payment |
Use this form to request payment for classroom coverage |
| Tutor Time Sheet |
Use this form when you tutor a student. |
| Tutor Letter |
This letter must be completed for non-lesson planning tutoring.
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| Tutor Letter |
This letter must be completed for lesson-planning tutoring.
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| DUFSD Action Plan Template |
Administrative Use Only.
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| Hourly Time Sheet |
For hourly employees only.
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| Substitute Time Sheet |
Substitutes only. |
| 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. |
| 2019 Empire BC/BS Alt PPO Summary of Benefits & Coverage |
Plan information regarding the Empire BC/BS Alt PPO Health Insurance Plan |
| 2019 Empire BC/BS EPO 20 Summary of Benefits & Coverage |
Plan information regarding the Empire BC/BS EPO 20 Health Insurance Plan |
| 2019 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 |
| 2019 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 |
| 2019 Empire BCBS Certificate of Coverage - Alt PPO |
Detailed plan information regarding the Empire BCBS Alt PPO Health Insurance Plan |
| 2019 Empire BCBS Certificate of Coverage - EPO 20 |
Detailed plan information regarding the Empire BCBS EPO 20 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 Henry Pollinger, Middle School Office). |