Welcome!
New Classified Management
Welcome to Cerritos College! The following documents are required to process new
employees and to be approved by the Board of Trustees. Print and complete all forms and
return to Rebecca Pang in Human Resources by appointment only (562) 860-2451 ext. 2281.
Thank you.
Please bring the following documents with you to your appointment:
Photo ID (current)
Social Security card (original)
Work Authorization (if applicable)
Official college transcripts with degree confer date
Proof of test for PPD-Tubersol/Mantoux (TB) or cleared chest X-ray within the last 3 ½ years
Forms to print, complete, and return:
LiveScan memo and form Cerritos College Campus Police fingerprints processing
I-9 Employment Eligibility Click on link and complete page 7
Oath of Allegiance
W-4 Click on the link and complete the Employee's Withholding Allowance Certificate
Emergency Contact
Injury & Illness Prevention Program (IIPP) Acknowledgement form
Workers’ Compensation Pre-Designation of Personal Physician
Direct Deposit option Provide a voided check with the completed form
Mailing Warrants Authorization option
Warrant Recipient Designation
CalPERS Member Form
Retirement Questionnaire
Staff Diversity Questionnaire
Verification of Receipt
Keep the following forms for your reference:
Academic Calendar
Work Calendar
Campus E-mail Instructions
Nondiscrimination
BP 7050 Conflict of Interest Policy
IIPP Packet
Procedure for New Web
AP 3720 Computer & Network Use Policy
AP 3518 Child Abuse Reporting Policy
Personal Safety on Campus
Employee Feedback
Rideshare Information Packet
Parking Permit Instructions
TB Memo & Referral
AP 3050 Code of Ethics Policy
Salary Schedule
New Hire Pamphlet
Employee Assistance Brochure
CalPERS Handbook Link
Links to CSEA Bargaining Agreement
STATE OF CALIFORNIA DEPARTMENT OF JUSTICE
BCII 8016
(orig. 4/01; rev. 6/09)
REQUEST FOR LIVE SCAN SERVICE
Applicant Submission
A1548
Employment
ORI (Code assigned by DOJ)
Authorized Applicant Type
Academic Employee
Type of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned)
Contributing Agency Information:
Cerritos College Human Resources Department
13749
Agency Authorized to Receive Criminal Record Information Mail Code (five-digit code assigned by DOJ)
11110 Alondra Blvd
Street Address or P.O. Box
Norwalk
CA 90650
City State ZIP Code
Applicant Information:
Adriana Flores-Church
Contact Name (mandatory for all school submissions)
(562) 860-2451
Contact Telephone Number
Last Name First Name Middle Initial Suffix
Other Name
(AKA or Alias)
Last First Suffix
Date of Birth
Sex
Male Female
Driver's License Number
Height Weight Eye Color Hair Color
Place of Birth (State or Country) Social Security Number
Billing
Number
Misc.
Number
143197
(Agency Billing Number)
(Other Identification Number)
Home
Address Street Address or P.O. Box City State ZIP Code
Your Number:
Management = $0
OCA Number (Agency Identifying Number)
Level of Service:
DOJ FBI
If re-submission, list original ATI number:
(Must provide proof of rejection)
Original ATI Number
Employer (Additional response for agencies specified by statute):
Employer Name Mail Code (five digit code assigned by DOJ
Street Address or P.O. Box
City State ZIP Code Telephone Number (optional)
Live Scan Transaction Completed By:
Name of Operator Date
Transmitting Agency LSID ATI Number Amount Collected/Billed
ORIGINAL - Live Scan Operator SECOND COPY - Applicant THIRD COPY (if needed) - Requesting Agency
Y: Forms: Oath of Allegiance
OATH OF ALLEGIANCE FOR PERSONS EMPLOYED BY
PUBLIC AGENCIES IN THE STATE OF CALIFORNIA
(Government Code Section 3102)
I, __________________________________, do solemnly swear (or affirm) that I will support and
defend the Constitution of the United States and the Constitution of the State of California
against all enemies, foreign and domestic; that I will bear true faith and allegiance to the
Constitution of the United State and the Constitution of the State of California; that I take this
obligation freely, without any mental reservation or purpose of evasion; and that I will well and
faithfully discharge the duties upon which I am about to enter.
____________________________________ ___________________________________
Signature of Employee Title of Position
Taken, subscribed and sworn to before me this ______ day of __________________, 20______
___________________________________ ___________________________________
Signature of Administrator Title
This oath must be signed by a Cerritos Community College District administrator involved in the
hiring and payroll process of management, faculty, classified, and student assistance employees
of the District
click to sign
signature
click to edit
Employment Eligibility Verification
Form I-9
It is a requirement of employment to fill out Form I-9.
Only fill out and print Section I on Page 7 of the booklet.
Please Click Here to Retrieve Form I-9
It is a requirement of employment to fill out Form W-4.
Please fill out and print.
Please Click Here to Retrieve Form W-4
Thank you
The Cerritos Community College District Board of Trustees, the District, and its
management pledge
to support the Injury Illness Prevention Program (IIPP) and to
ensure that it remains a viable method
of protecting all employees and all other site
occupants, as well as to meet its obligations of
maintaining a safe and healthful work
place.
The IIPP is a basic written workplace safety program. Title 8 of the California Code of
Regulations
(T8CCR) section 3203, requires every employer to develop and implement
an effective IIPP. It is
the District's responsibility to communicate the IIPP to all its
employees and it is the employee's
responsibility to read and comply with the provisions
of the IIPP and health and safety regulations.
By signing this form, I acknowledge receipt of Cerritos College's Injury Illness
Prevention Program. I
understand that any questions about the IIPP or any safety
related concerns should be directed to the
Risk Manager, Site Manager, or
representative in the Safety Committee.
Employee's Full Name (print)
Date Employee's Signature
UPON COMPLETION OF THIS FORM,
FORWARD TO
HUMAN RESOURCES/RISK MANAGEMENT
Adriana Flores-Church, Ed.D.
Risk Management
(562) 860-2451 Ext 2283
Injury Illness Prevention Program
Acknowledgement Form
EMPLOYEE ADDRESS/TELEPHONE/EMERGENCY CONTACT INFORMATION
EMPLOYEE ADDRESS/TELEPHONE INFORMATION
Last Name First Name MI
Home/Mailing Address
Home Phone Number Cell Phone Number
EMPLOYEE TYPE (CHECK ONE):
Full-Time Faculty
Confidential
Part-Time Faculty
Management
Classified
Signature of Employee Date
EMERGENCY CONTACT INFORMATION
Please provide the name(s) of a person(s) (and other information requested below) the District
should contact in case of an emergency (serious injury, sudden illness, etc.).
Last Name First Name MI Relationship
Home Address City State Zip
Home Phone Number Work Phone/Cell Phone Number Place of Employment
Last Name First Name MI Relationship
Home Address City State Zip
Home Phone Number Work Phone/Cell Phone Number Place of Employment
Form 122012
Cerritos College
Workers’ Compensation: Pre-Designation of Personal Physician
If you have health insurance and you are injured on the job you have the right to be treated immediately by your personal physician
(M.D., D.O), or medical group, if you notify your employer, in writing, prior to the injury. Per Labor Code 4600 to qualify as the your
predesignated, personal physician, the physician must agree, in writing, to treat you for a work related injury, must have
previously directed your medical care and must retain your medical history and records. Your predesignated physician must be a
family practitioner, general practitioner, board certified or board eligible internist, obstetrician-gynecologist or pediatrician. Your
“personal physician” may be a medical group if it is a single corporation or partnership composed of licensed doctors or medicine or
osteopathy, which operates an integrated multi-specialty medical group providing comprehensive medical services predominantly for
non-occupational illnesses and injuries.
This is an optional form that can be used to notify your employer of your personal physician. You may choose to use another form, as
long as you notify your employer, in writing, prior to being injured on the job and provide written verification that your personal
physician meets the above requirements and agrees to be predesignated. Otherwise, you will be treated by one of your employers’
designated workers’ compensation medical providers.
EMPLOYEE NAME: ______________________________________________________________________________
I acknowledge receipt of this form and elect not to predesignate my personal physician at this time. I understand that I will receive
medical treatment from my employers’ medical provider. I understand that, at any time in the future, I can change my mind and
provide written notification of my personal physician. I understand that the written notification must be on file prior to an industrial
injury.
Employee Signature: __________________________________________________________ Date: ______________
If I am injured on the job, I wish to be treated by my personal physician*:
Name
of Physician or Medical Group ________________________________________ Phone Number ___________________
Address _________________________________________________________________________
*This physician is my personal primary care physician who has previously directed my medical care and retains my medical history and
records.
Employee Signature: __________________________________________________________ Date: ______________
A Personal Physician must be willing to be predesignated and treat you for a workers’ compensation injury.
The remainder of this form is to be completed by your physician and returned to your Employer.
P E R S O N A L P H Y S I C I A N A C K N O W L E D G E M E N T
Per Labor Code 4600 to qualify you must meet the criteria outlined above. You are not required to sign this form, however, if you or your
designated employee, does not sign, other written documentation of the physicians’ agreement to be predesignated will be required
pursuant to Title 8, California Code of Regulations, section 9780.1(a)(3).
PERSONAL PHYSICIAN OR MEDICAL GROUP NAME: _________________________________________________________
I agree to treat the above named employee in the event of an industrial accident or injury. I meet the criteria outlined above. I
agree to adhere to the Administrative Director’s Rules and Regulations, Section 9785, regarding the duties of the employee-
designated physician.
I do not agree to treat the above employee in the event of an industrial accident or injury.
I do not qualify as the employees’ personal physician. I am not an M.D. or D.O. or do not meet the criteria outlined above.
______________________________________________________ _______________________
(Physician or Designated Employee of the Physician or Medical Group) Date
Please return completed form to:
Cerritos College 11110 Alondra Blvd., Norwalk, CA 90650 (562) 860-2451
Payroll Unit
deposits and, as necessary, debit corrections to previous deposits to my account.
I understand:
Direct deposit status is not activated until 10 days following a Direct deposit will also be suspended if a a certificated
$0 test transaction for new or change authorization. employee's credential expires.
I must submit a new Employee's Direct Deposit Authorization, Direct deposit status may be suspended or rescinded by
Form No. 501-508, if I change my account the district or LACOE and payment made by county
(name, institution, branch, type account, etc.). warrant, if necesasry, to meet payroll deadlines or under
extreme conditions.
Direct deposit status will be temporarily suspended if wages
are garnished.
I agree to hold harmless and indemnify the district and Los Angeles County Office of Education and its officers, employees, and agents
from any claim or demand of whatever nature, including those based upon negligence of LACOE and its officers, employees, and
agents for failure or delay in making deposits and/or corrections to deposits as herein authorized.
This authorization replaces any previously made by me and is to remain in effect until changed or canceled by submission of a new
Employee's Direct Deposit Authorization.
ATTACH BELOW A VOIDED CHECK
SHOWING THE INSTITUTION ROUTING
NUMBER AND ACCOUNT NUMBER.
SIGNATURE OF EMPLOYEE
x
DATE SIGNED
ATTACH VOIDED CHECK HERE
FOR COUNTY OFFICE USE ONLY
Refer to the Direct Deposit Reference Guide
INPUT BY (PRINT NAME)
GR 9/2007
FINA NCI AL I NSTI TUT ION RO UTIN G NO.
PLEASE CHECK
N
ew Change
Direct Deposit Authorization
PRINT LAST NAME, FIRST NAME, MIDDLE INITIAL SOCIAL SECURITY NUMBER
N
AME OF SCHOOL DISTRICT (IF EMPLOYED WITHIN THE OFFICE, PUT YOUR ROOM NUMBER HERE) WORK TELEPHONE NUMBER
(
)
AME OF BANK/CREDIT UNION/SAVINGS & LOAN BRANCH TELEPHONE NUMBER
(
)
Checking
Savings
ACCOUNT NUMBER ADDRESS OF BANK/CREDIT UNION/SAVINGS & LOAN (NUMBER,STREET,CITY AND ZIP CODE)
I hereby authorize the district and the Los Angeles County Office of Education (LACOE) and/or its agents to initiate electronic
Cancel
EMPLOYEE'S DEPOSIT ACCOUNT NO.
Cerritos College Employee’s Direct Deposit
Information and Instructions
1. Direct deposit is a voluntary program which will transfer your net pay directly to your checking
or savings account. Instead of a pay warrant, you will receive an advice of the amount
deposited attached to your pay stub. The entire net check amount must be deposited, and
the deposit can only be direct to one checking or savings account per employee.
2. Things to consider:
Your bank, S&L, or credit union must be a member of a National Automated
Clearinghouse Association, which most institutions are.
A garnishment order will temporarily suspend direct deposit status.
If you have more than one assignment with the District on regular payroll cycles, all
pay will go direct deposit.
Retroactive checks and adjustments checks which are paid on a supplemental
schedule, will not be direct deposited. When regular pay is reissued on a supplemental
schedule, you will receive an actual payroll warrant.
3. How to sign up:
Complete Employee’s Direct Deposit Authorization form. Attach a voided check for
verifying routing numbers and/or account numbers.
Return the completed form to the Payroll Office
Payroll will enter the information in the county’s payroll system for a test run. An
advice (direct deposit) will issue for $0.00 which will be forwarded to the employee.
Employee should verify the account number for accuracy. If there is a discrepancy,
please contact the Payroll Office immediately.
The first check to be direct deposited will be on or after the start-up date indicated on
the pre-notification.
4. Submit a new authorization form to Payroll when:
you change the name on the account
you close the account or move the account from one branch to another
you are absent for more than a semester or year
5. Additional provisions (Please read carefully):
Employees will be responsible for any fees, charges or costs assessed by Los Angeles
County Office of Education and/or my bank institution due to my failure to cancel or
modify my Direct Deposit Authorization. Such fees, charges or costs will be deducted
from my payroll warrant.
Employees understand and agree that a replacement payroll warrant will not be issued
to said employee, or on behalf of said employee, if a Direct Deposit Authorization is
invalidated by a transfer of banking account(s) or banking institution until/unless Los
Angeles County Office of Education has confirmed the receipt of the returned
funds/payroll warrant. Please not the return of incorrect Direct Deposit funds could
delay issuance of a replacement payroll warrant for approximately 10 to 15 working
days.
Direct deposit is not automatically canceled when you close the account to which your
pay is being deposited. You must cancel direct deposit with the Payroll Office before you
close the account at the financial institution.
Cancelling your direct deposit can be accomplished via email to the Payroll Office.
(Deanna Hart, Payroll Manager)
(John Thein, Payroll Technician)
(Barbara Young, Payroll Technician)
(Karla Duarte, Payroll Technician)
kduarte@cerritos.edu
bjyoung@cerritos.edu
jthein@cerritos.edu
dhart@cerritos.edu
Cerritos Community College District
Authorization for Mailing Payroll Warrants
This form must be completed and submitted to the District Payroll Department if you
wish to have your payroll warrants mailed to you at your home (mailing) address at the
District's expense. Please complete the following information:
Name
Please Print
(Last) (First) (MI)
Division/Department
Full-Time Faculty Part-Time Faculty Management
Classified Confidential Student/Adult Hourly
I understand that this authorization applies to all warrants (regular, part-time, overload,
summer school, and/or student/adult hourly). No deviation will be made from the
method of delivery authorized herein for the remainder of this academic year. Changes
in the method of delivery of warrants can only be made at the beginning of a new
academic year unless otherwise approved by the Payroll Department.
The warrants will be mailed on the same day on which they are received from the Los
Angeles County Office of Education.
Please Note: The District is not responsible for payroll warrants lost in the mail. It
is the employee's responsibility to notify the District of changes of address.
Date Signature of Employee

The following section is to be used only for the purpose of an employee requesting to
rescind his/her authorization for mailing of payroll warrants.
I hereby request that the District discontinue the mailing of my
payroll warrants as previously authorized.
Name
Please Print (Last) (First) (MI)
Division/Department
Full-Time Faculty Part-Time Faculty Management
Classified Confidential Student/Adult Hourly
Date Signature of Employee
WARRANT RECIPIENT DESIGNATION
In accordance with the provisions of Section 53245 of the California Government Code, in the event
of my death, I hereby designate the following persons (designees) to receive any and all warrants
payable to me.
Designee #1
Name ___________________________________________ Relationship: _______________________
Address: ______________________________ City: ____________________ State: ____ Zip: _______
OR, in the event of the death of Designee #1,
Designee #2
Name ___________________________________________ Relationship: _______________________
Address: ______________________________ City: ____________________ State: ____ Zip: _______
This designation form cancels and replaces any designation form previously signed for this purpose
and shall remain in effect until cancelled in writing by me.
It is understood and agreed that the Cerritos Community College District is not obligated to deliver
said warrants to the designee unless the designated person claims such warrants from the District
and provides sufficient proof of identity. A person so designated may negotiate the warrant(s) as if
the payee.
Employee Name (print): _____________________________________________
Employee Signature: ______________________________________ Date: _____________
Management Faculty Classified Short-Term Hourly
School District/Agency: Cerritos Community College District
Submit this completed form to the Office of Human Resources
PeopleSoft: ___________
Cerritos College
Human Resources Office
TO: Faculty, Management, Classified & Confidential Employees
FROM: Human Resources Office
SUBJECT: Home Address/Telephone Number Restriction From Disclosure to
Requesting Employee Organizations
The District in accordance with the provisions of Government Code Section 6254.3
maintains home address and telephone information for employees as confidential
information. Government Code Section 6254.3 provides for the disclosure of this
information to requesting employee organizations unless an employee requests that
such information not be disclosed.
In accordance with the provisions of Government Code Section 6254.3, upon a written
request by an employee, the District shall not disclose the employee's home address or
home telephone number to requesting employee organizations.
This is to request that you complete the section below and indicate whether or not you
wish to restrict your home address and/or home telephone number from disclosure to
requesting employee organizations.
In accordance with the provisions of Government Code Section 6254.3, I hereby
request that my home address and telephone number are to be handled in the following
manner for requests from employee organizations:
Home Address:
Restricted from disclosure
Not restricted from disclosure
Home Telephone Number:
Restricted from disclosure
Not restricted from disclosure
Print Name Date
Signature 2014
California Public Employees’ Retirement System
Customer Account Services Division
Retirement Account Services Section
P.O. Box 942709
Sacramento, CA 94229-2709
TTY: (877) 249-7442
888 CalPERS (or 888-225-7377) phone (916) 795-4166 fax
www.calpers.ca.gov
PERS-CASD-801 (12/12)
MEMBER RECIPROCAL SELF-CERTIFICATION FORM
Complete the following information and return this form to your Personnel Office within 10 business days:
EMPLOYEE NAME: ______________________________________________________________________
(Last) (First) (Middle)
SOCIAL SECURITY NUMBER OR CalPERS ID NUMBER: ______________________________________
NAME OF MOST RECENT RECIPROCAL RETIREMENT SYSTEM: _______________________________
PERMANENT SEPARATION DATE FROM MOST RECENT RECIPROCAL RETIREMENT SYSTEM: _____
_______________________________________________________________________________________
FIRST MEMBERSHIP DATE IN ANY PRIOR CALIFORNIA PUBLIC RETIREMENT SYSTEM THAT IS
SUBJECT TO RECIPROCITY: ______________________________________________________________
(Check the applicable statement)
_____ I have not been a member of another California Public Retirement System within the last six months.
_____ I was a member and am retired from the _______________________________ Retirement System and
subsequently became employed by a CalPERS-covered employer.
_____ I was a member of the _____________________________ Retirement System and became employed by
a CalPERS-covered employer within six months after separating from employment with the previous
reciprocal retirement system.
I understand that by accepting employment in a specific retirement system, I am subject to the applicable laws and
regulations of that system. I also understand that completing this form does not constitute a request to establish
reciprocity. I must complete and return the “Election to Coordinate Retirement When Changing Retirement
Systems,” (PERS-MSD-255) Form to CalPERS.
I hereby certify that the foregoing information is true and correct and any information found to be incorrect may
require corrections to my account in the California Public Employees’ Retirement System including, but not limited
to, my date of membership. CalPERS may make any necessary corrections to my account to ensure I am properly
enrolled and eligible to receive the correct retirement benefits.
______________________________________________ ______________________________
SIGNATURE OF EMPLOYEE DATE
TO BE COMPLETED BY EMPLOYER ONLY:
NAME OF CalPERS AGENCY: CalPERS BUSINESS PARTNER ID:
__________________
____________________________ _______________________________________
C
alPERS MEMBERSHIP ELIGIBILITY DATE ORIGINAL HIRE DATE WITH YOUR AGENCY:
WITH YOUR AGENCY:
__________________
____________________________ _______________________________________
DATE MEMBER RECIPROCAL SELF-CERTIFICATION FORM GIVEN TO EMPLOYEE: ________________
DATE MEMBER RECIPROCAL SELF-CERTIFICATION FORM RECEIVED FROM EMPLOYEE: __________
______________________________________ _________________ _____________
(Please Print) DESIGNEE OF EMPLOYER TITLE DATE
________________________________________________________________________________________
DESIGNEE’S SIGNATURE
1315715064
PERS-CASD-801 (12/12)
MEMBER RECIPROCAL SELF-CERTIFICATION FORM
Instructions
Reciprocity is an agreement among public retirement systems to allow members to separate from one
public employer and enter into employment with another public employer within a specific time limit
without losing some valuable retirement and related benefit rights.
The Public Employees’ Pension Reform Act of 2013 (PEPRA), effective January 1, 2013, requires a
CalPERS covered employer to determine the applicable PEPRA retirement benefit formula for new
employees. CalPERS refers to all members that do not fit within the PEPRA definition of a “new
member
1
” as “classic members” who are subject to the Public Employees’ Retirement Law (PERL).
PEPRA allows a member after January 1, 2013, to retain his/her classic member retirement benefit
status if the member continues his/her membership in all previous California Public Retirement
System(s) by leaving his/her service credit and contributions (if any) on deposit, and the member
enters into employment that results in CalPERS membership within six months of separating from the
most recent California Public Retirement System. Classic member status also requires the
membership date to be on or before December 31, 2012, in a California Public Retirement System in
which reciprocity is established.
EMPLOYER INSTRUCTIONS
1. Employers must provide the Member Reciprocal Self-Certification Form to all new employees
upon eligibility for membership.
2. Employers must sign and date the Member Reciprocal Self-Certification Form on the date the form
is given to the employee.
3. Upon receipt of the completed Member Reciprocal Self-Certification Form, the employer will enter
the date the employee returns the form.
4. The employer will enroll the new employee into CalPERS membership through my|CalPERS
bas
ed on the information provided on the Member Reciprocal Self-Certification Form.
my|CalPERS will determine the proper retirement benefit formula. If an employer believes t
he
r
etirement benefit formula is incorrect, employers may contact CalPERS at 1-888-225-7377.
5. It is the responsibility of the employer to retain the completed Member Reciprocal Self-Certification
Form in the employee’s employment records for auditing purposes.
1
A new member is defined in PEPRA as any of the following:
A new hire who is brought into CalPERS membership for the first time on or after January 1, 2013, who has
no prior membership in any California Public Retirement System.
A new hire who is brought into CalPERS membership for the first time on or after January 1, 2013, who has
a break in service of greater than six months with another California Public Retirement System that is
subject to Reciprocity.
A member who first established CalPERS membership prior to January 1, 2013, who is rehired by a
different CalPERS employer after a break in service of greater than six months.
PERS-CASD-801 (12/12)
EMPLOYEE INSTRUCTIONS
1. The Member Reciprocal Self-Certification Form will assist your employer in determining whether
you are considered a new member or a classic member under PEPRA.
2. As the new employee, you must complete, sign and date the Member Reciprocal Self-Certification
Form to self-certify your most recent service in a reciprocal California Public Retirement System,
your first membership date in any previous California Public Retirement System and your
permanent separation date from the most recent California Public Retirement System; or indicate
that you are not a member of any California Public Retirement System that is subject to
Reciprocity.
3. As the new employee, you must return the Member Reciprocal Self-Certification Form to your
Personnel Office within 10 business days of employment.
4. The completion of the Member Reciprocal Self-Certification Form does not establish reciprocity
and is not a request to establish reciprocity. In order to request that reciprocity be established,
visit the CalPERS web-site at: www.calpers.ca.gov
and download the publication: “When You
Change Retirement Systems”, PUB-16. It is the responsibility of the employee to complete
and send the “Election to Coordinate Retirement When Changing Retirement Systems,”
PERS-MSD-255 Form to CalPERS.
Reciprocal 1937 Act Counties Reciprocal Public Agencies
Alameda Sacramento *City of Concord
Contra Costa San Bernardino *City of Costa Mesa (Safety employees only)
Fresno San Diego City of Fresno (Miscellaneous and
Imperial San Joaquin Safety Retirement Systems)
Kern San Mateo City of Los Angeles (non-Safety only)
Los Angeles Santa Barbara City of Oakland (non-Safety
Marin Sonoma employees only)
Mendocino Stanislaus City of Pasadena (Fire and Police
Merced Tulare Retirement System)
Orange Ventura *City of Sacramento
*City of San Clemente (non-Safety
employees only)
Non-Reciprocal & UCRS Retirement Systems City of San Diego
*City and County of San Francisco
Non-reciprocal systems are not covered by City of San Jose
reciprocity retirement laws, but participate Contra Costa Water District
in retirement agreements with other systems. County of San Luis Obispo
East Bay Municipal Utility District
State Teachers’ Retirement System East Bay Regional Park District
Legislators’ Retirement System (Safety employees only)
Judges’ Retirement System Los Angeles County Metropolitan
Judges’ Retirement System II Transportation Authority
University of California Retirement System (Non-Contract Employees’ Retirement
Income Plan, formerly Southern
California Rapid Transit District)
*Also CalPERS-covered agency
CERRITOS COMMUNITY COLLEGE DISTRICT
11110 Alondra Blvd. Norwalk, CA 90650
QUESTIONNAIRE FOR NON-ACADEMIC EMPLOYEES WHO ARE NEW TO THIS DISTRICT
Last Name ____________________________ First Name _______________________ MI _______
Street Address _________________________________________________________________
City _______________________________________________ Zip _____________________
Date of Birth _______________ Telephone _______________________ Student ID _______________
Employment Status
___ Classified ___ Short Term Temporary Hourly
___ Management ___ Federal Work Study
Have you ever worked in another school district? ________
If yes, which one? _________________________________________ When? _____________________
Retirement Status
1. Are you a member of the California Public Employees’ Retirement System (PERS)? Yes No
Have you ever withdrawn these funds? ______ If yes, date of withdrawal __________________
Have you re-deposited these funds? ______ When? __________________
Are you contributing into the Public Employees’ Retirement System in any other state or governmental
agency? _____ Full-time or Part-time ___________ if so, where? ____________________________
What was the effective date of your membership into the system? __________________
2. Are you a member of the State Teachers’ Retirement System (STRS)? Yes No
Have you ever withdrawn these funds? ______ If yes, date of withdrawal __________________
Have you re-deposited these funds? ______ When? __________________
Are you contributing into the State Teachers’ Retirement System in any other state or governmental
agency? _____ Full-time or Part-time ___________ if so, where? ____________________________
What was the effective date of your membership into the system? __________________
Are you employed in any other district during this school year? _______ If so, list:
County
District
Regular
% of Full-Time
Sub
Hourly
(Continued on Reverse)
CERRITOS COMMUNITY COLLEGE DISTRICT
11110 Alondra Blvd. Norwalk, CA 90650
NON-CERTIFICATED EMPLOYEES PERS REGULATIONS REQUIRING MEMBERSHIP.
PLEASE READ CAREFULLY.
1. Student Hourly employees are excluded from membership in PERS
2. Persons who have funds on deposit with PERS cannot be excluded from membership regardless of the
type of appointment, permanent or temporary, at the time of employment.
3. Classified Employees become members of PERS on the first day of employment if the position
requires service for at least an average of 20 hours per week.
Part-Time Classified Employees become members from the first day of employment if the position
requires service for at least an average of 20 hours per week.
4. Temporary full-time employees employed for a specific duration (more than six months), become
members on the first day of employment. If length of employment is for less than six months, but
employment is subsequent extended past six months, the individual is excluded from PERS membership
for only the first six months of services. Membership is effective not later than the first day of the
seventh month of employment.
5. Regular Classified Hourly employees and Temporary Adult Hourly or Substitute Hourly employees
employed on an irregular or “as needed” basis become members only if they work 1,000 hours or 125
days within one fiscal year. Membership will be effective on the first day of the month following the
month in which the 1,000 hours of 125 days of service were completed.
QUALIFYING EMPLOYEES WHO BECOME MEMBERS IN PERS MUST ALSO PARTICIPATE AND
CONTRIBUTE IN THE SOCIAL SECURITY SYSTEM.
ACCEPTANCE OF EMPLOYMENT IN A POSITION REQUIRING MEMBERSHIP IN THE SYSTEM IS
YOUR CONSENT TO HAVE DEDUCTIONS FROM SALARY TAKEN FOR PERS AND SOCIAL
SECURITY SYSTEM.
Signature
Date
Cerritos Community College District
Staff Diversity Information Questionnaire
This form is to be completed by all employees of the District. This information is required by the
District for research, evaluation, and federal/state reporting purposes. Please print and check
the appropriate boxes to provide the following information:
Name:
Gender:
Male
Female
(Last, First, MI)
Date of Birth:
Month/Day/Year
Ethnic Group (with which you most closely identify):
Asian or Pacific Islander
Hispanic/Latino
Chinese
Hawaiian
Mexican, Mexican-American, Chicano
Japanese
Guamanian
Central American
Filipino
Samoan
South American
Korean
Laotian
Other Hispanic
Vietnamese
Cambodian
Asian Indian
Pacific Islander Other
Asian Other
American Indian/Alaskan Native
African American/Black
Caucasian/White
Disabilities - Substantially limited to one or more major life activities and having a
record of a vision, mobility, hearing, speech, learning or mental impairment or being
regarded as having such impairment.
None
Yes, please identify
Vietnam Era Veteran (August 4, 1964 - May 5, 1975):
No
Yes
List any relative(s) employed by the District:
Name
Position
Division/Department
Relationship
Signature of Employee
Date
2014
Cerritos Community College District
Verification of Receipt of New Employee Information
(Management)
Y:Beryl_Donna/Processing Forms for New Hires/Receipt New Management 2014 2014
I hereby certify that I have received the following items from the Human Resources office as
part of my new employment processing:
Academic and Fiscal Calendars
AP 3050 Institutional Code of Ethics
AP 3518 Child Abuse & Neglect Reporting
BP 7050 Conflict of Interest Notice
Campus Map
Campus E-mail Instructions
CCFF Collective Bargaining Agreement (online)
Classified Employees’ Handbook
CSEA-District Collective Bargaining Agreement
Computer & Network use Administrative Policy
Direct Deposit Information (Pay Warrant)
Employee Assistance Program Brochure
Employee Feedback Form
Faculty Handbook (online)
ID Card and Instructions
Injury Illness Prevention Program
Management Salary Schedule
Non-Discrimination Policy & Procedures Brochure
Personal Physician Designation Form (Work Related Injury) & New Hire Pamphlet
Personal Safety on Campus Brochure
Request for Transfer of Sick Leave
Rideshare Bulletin
STRS or PERS Handbook (online) & Beneficiary Designation Form
Student Health & Wellness Center Brochure
Tuberculin Test Memorandum
Employee Name (Print)
Signature of Employee
Date
Signature of Human Resources Office
Date
click to sign
signature
click to edit
2014-2015 Work Calendar
S M T W TH F S S M T W TH F S Jul 4 Independence Day
1 2 3 4 5 1 2 3
6 7 8 9 10 11 12 4 5 6 7 8 9 10 Sep 1 Labor Day
13 14 15 16 17 18 19 11 12 13 14 15 16 17
20 21 22 23 24 25 26 18 19 20 21 22 23 24 Nov 11 Veteran's Day
27 28 29 30 31 25 26 27 28 29 30 31
Nov 27 Thanksgiving Day
S M T W TH F S S M T W TH F S Nov 28 Board Approved Holiday
1 2 (Friday after Thanksgiving)
3 4 5 6 7 8 9 1 2 3 4 5 6 7
10 11 12 13 14 15 16 8 9 10 11 12 13 14 Dec 24 Board Approved Holiday
17 18 19 20 21 22 23 15 16 17 18 19 20 21
24 25 26 27 28
29 30
22 23 24 25 26 27 28 Dec 25 Christmas Day
31
Dec 26 Board Approved Holiday
S M T W TH F S S M T W TH F S Dec 29 Board Approved Holiday
1 2 3 4 5 6
7 8 9 10 11 12 13 1 2 3 4 5 6 7 Dec 30 Board Approved Holiday
14 15 16 17 18 19 20 8 9 10 11 12 13 14
21 22 23 24 25 26 27 15 16 17 18 19 20* 21 Dec 31 Board Approved Holiday
28 29 30 22 23 24 25 26 27 28
29 30 31 Jan 1 New Year's Day
Jan 19 Dr. Martin Luther King, Jr. Day
S M T W TH F S S M T W TH F S
1 2 3 4 1 2 3 4 Feb 13 Abraham Lincoln Day
5 6 7 8 9 10 11 5 6 7 8 9 10 11
12 13 14 15 16 17 18 12 13 14 15 16 17 18 Feb 16 George Washington Day
19 20 21 22 23 24 25 19 20 21 22 23 24 25
26 27 28 29 30 31 26 27 28 29 30 Mar 20 Board Approved Holiday
(Friday of Spring Break)
S M T W TH F S S M T W TH F S May 25 Memorial Day
1 1 2
2 3 4 5 6 7 8 3 4 5 6 7 8 9
9 10 11 12 13 14 15 10 11 12 13 14 15 16
16 17 18 19 20 21 22 17 18 19 20 21 22 23
23 24 25 26 27 28* 29 24 25 26 27 28 29 30
30 31
S M T W TH F S S M T W TH F S
1 2 3 4 5 6 1 2 3 4 5 6
7 8 9 10 11 12 13 7 8 9 10 11 12 13
14 15 16 17 18 19 20 14 15 16 17 18 19 20
21 22 23 24* 25 26* 27 21 22 23 24 25 26 27
28 29* 30* 31* 28 29 30
*Board Approved Holiday
Adopted by the Board of Trustees
January, 2015
February, 2015
March, 2015
September, 2014
May, 2015
November, 2014
December, 2014
June, 2015
May 21, 2014
Cerritos College
Holidays
July, 2014
August, 2014
April, 2015
October, 2014
3/13/14
Cerritos College Academic Calendar 2014-2015
SUMMER SESSION 2014
May 27 August 15
May 26 Memorial Day
July 4 Independence Day
FALL SEMESTER 2014
August 18 December 19
August 18 October 17 First 9-Week Session
September 1 Labor Day
September 8 December 19 15-Week Intrasession
October 20 December 19 Second 9-Week Session
November 11 Veteran’s Day
November 27 30 Thanksgiving
December 13 19 Final Exams
SPRING SEMESTER 2015
January 12 May 22
January 5 9 Flex Week
January 12 March 13 First 9-Week Session
January 19 Martin Luther King, Jr.’s Birthday
February 2 May 22 15-Week Intrasession
February 13 Lincoln’s Birthday
February 16 Washington’s Birthday
March 16 March 22 Spring Recess
March 23 May 22 Second 9-Week Session
May 18 22 Final Exams
SUMMER SESSION 2015
May 26 August 14
May 25 Memorial Day
July 4 Independence Day
Dates are subject to renegotiation if the District adopts a
compressed calendar.
May 2014
S M T W T F S
1 2 3
4 5 6 7 8 9 10
11 12 13 14 15 16 17
18 19 20 21 22 23 24
25 26 27 28 29 30 31
July 2014
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 30 31
August 2014
S M T W T F S
1 2
3 4 5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23
24 25 26 27 28 29 30
31
September 2014
S M T W T F S
1 2 3 4 5 6
7 8 9 10 11 12 13
14 15 16 17 18 19 20
21 22 23 24 25 26 27
28 29 30
October 2014
S M T W T F S
1 2 3 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18
19 20 21 22 23 24 25
26 27 28 29 30 31
November 2014
S M T W T F S
1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30
January 2015
S M T W T F S
1 2 3
4 5 6 7 8 9 10
11 12 13 14 15 16 17
18 19 20 21 22 23 24
25 26 27 28 29 30 31
February 2015
S M T W T F S
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
March 2015
S M T W T F S
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31
April 2015
S M T W T F S
1 2 3 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18
19 20 21 22 23 24 25
26 27 28 29 30
May 2015
S M T W T F S
1 2
3 4 5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23
24 25 26 27 28 29 30
31
July 2015
S M T W T F S
1 2 3 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18
19 20 21 22 23 24 25
26 27 28 29 30 31
August 2015
S M T W T F S
1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30 .31
June 2014
S M T W T F S
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30
December 2014
S M T W T F S
1 2 3 4 5 6
7 8 9 10 11 12 13
14 15 16 17 18 19 20
21 22 23 24 25 26 27
28 29 30 31
June 2015
S M T W T F S
1 2 3 4 5 6
7 8 9 10 11 12 13
14 15 16 17 18 19 20
21 22 23 24 25 26 27
28 29 30
Legend
Semester Start Days
Semester End Days
Holidays
CAMPUS E-MAIL INSTRUCTIONS
(Classified & Confidential Employees)
1. Contact division/department secretary or
your immediate manager to make sure
request has been made for you to have
access to the computer system.
2. Get your user ID and temporary password
from either the division/department
secretary or your immediate manager.
3. Call the innovation center at extension
#2797 to set up a training appointment.
The innovation center will train you on how to
gain access into the computer system and your
email account.
Cerritos Community College District
Nondiscrimination and Sexual Harassment
All members of the campus community, including you, have the right to work and study
in an environment free of discrimination and sexual harassment.
What is sexual harassment?
Board Policy 3430 contains the Districts zero tolerance policy against all forms of harassment, including sexual
harassment. Sexual harassment is a form of unlawful discrimination. District Board Policies, state and federal laws
prohibit all forms of unlawful discrimination.
Board Policy 3410 and Administrative Procedure 3410 describes the District’s commitment to nondiscrimination
and Administrative Procedure 3435 explains how reports and complaints of discrimination are filed and
investigated. You may contact Human Resources with questions and to make reports at (562) 860-2451, extension
2284.
The District’s Board Policies and Administrative Procedures may be found on the District’s website at
http://cms.cerritos.edu/board/policies/. Excerpts of District Board Policy 3410: Nondiscrimination, and Board
Policy 3430: Prohibition of Harassment are included below.
You should know that you have a duty to report discrimination or sexual harassment if:
You have become aware of acts of discrimination or sexual harassment.
You have witnessed acts of discrimination or sexual harassment.
Any member of the campus community has reported acts of discrimination or sexual harassment to you.
If you need to ask questions, get information, or make a report, you may contact:
Mr. Barrett Morris Ms. Amna Jara
Director of Diversity, Benefits, Interim Dean, Student Services
and Compliance Student Activities Office
Title IX Coordinator (562) 860-2451, extension 2474
Human Resources Office ajara@cerritos.edu
(562) 860-2451, extension 2276
bmorris@cerritos.edu
Dr. Stephen Johnson Dr. Lucinda Aborn
Vice President, Student Services Dean, Disabled Students Programs and
Student Services Office Services (DSPS)
(562) 860-2451, extension 2236 DSPS Office/Santa Barbara Building
sjohnson@cerritos.edu (562) 860-2451, extension 2345
laborn@cerritos.edu
Individuals with concerns about discrimination or sexual harassment may also contact any manager for immediate
assistance. For disability concerns, please contact Mr. Barrett Morris or Dr. Lucinda Aborn. If you are interested
in Sexual Harassment Training, you may contact Human Resources at (562) 860-2451, extension 2284.
Information concerning discrimination and complaints of discrimination can also be obtained from:
U.S. Equal Employment California Department of Fair
Opportunity Commission Employment and Housing
www.eeoc.gov www.dfeh.ca.gov
2014
U.S. Department of Education (for discrimination in student or educational matters)
Office for Civil Rights
www.ed.gov/offices/OCR
EMPLOYEE ASSISTANCE PROGRAM (EAP)
Cerritos College provides an EAP to help its employees and their immediate families with problems related to
stress; marital, working and relationship difficulties; financial and legal problems; alcohol and drug use or
addiction. Information concerning the District-paid EAP Plan may be obtained through Human Resources, (562)
860-2451, extension 2284.
It is hard to be alone when you or someone you care for is having problems. Our employees are our most valuable
asset and the District encourages its employees to seek assistance when facing problems.
BOARD POLICY EXCERPTS
Board Policy 3410: Nondiscrimination
The District is committed to equal opportunity in educational programs, employment, and all access to
institutional programs and activities.
The District, and each individual who represents the District, shall provide access to its services, classes, and
programs without regard to national origin, religion, age, gender, gender identity, gender expression, race or
ethnicity, color, medical condition, genetic information, ancestry, sexual orientation, marital status, physical or
mental disability, pregnancy, or because he or she is perceived to have one or more of the foregoing
characteristics, or based on association with a person or group with one or more of these actual or perceived
characteristics.
The President/Superintendent shall establish administrative procedures that ensure all members of the College
community can present complaints regarding alleged violations of this policy and have their complaints heard in
accordance with the Title 5 regulations and those of other agencies that administer state and federal laws
regarding nondiscrimination.
Board Policy 3430: Prohibition of Harassment
All forms of harassment are contrary to basic standards of conduct between individuals and are prohibited by
state and federal law, as well as this policy, and will not be tolerated. The District is committed to providing an
academic and work environment that respects the dignity of individuals and groups. The District shall be free of
sexual harassment and all forms of sexual intimidation and exploitation including acts of sexual violence.
The District seeks to foster an environment in which all employees and students feel free to report incidents of
harassment without fear of retaliation or reprisal. Therefore, the District also strictly prohibits retaliation against
any individual for filing a complaint of harassment or for participating in a harassment investigation. Such conduct
is illegal and constitutes a violation of this policy.
Any student or employee who believes that he or she has been harassed or retaliated against in violation of this
policy should immediately report such incidents by following the procedures described in AP 3435 titled
Discrimination and Harassment Investigations. Supervisors are mandated to report all incidents of harassment
and retaliation that come to their attention.
2014
Cerritos Community College District Policy No. 7050
Human Resources
BP 7050 EMPLOYEE CONFLICT OF INTEREST
1
References: 2
Government Code, Sections 1126, 82029, 87100, 87302; 3
CCR, Title 2, Section 18705 4
The following policy pertains to all employees of the Cerritos Community College 5
District. 6
A. CONFLICTS OF INTEREST ARE PROHIBITED 7
No employee or consultant/contractor of the Cerritos Community College District 8
shall make, participate in making, or in any way attempt to influence a decision of 9
the Cerritos Community College District in which he or she knows or has reason 10
to know will have a financial effect, distinguishable from its effect on the public 11
generally, on the employee or his or her “immediate family.” Immediate family 12
shall mean spouse and dependent children of an employee of the District 13
(Government Code, Section 82029), which includes: 14
1. Any business entity in which the employee, consultant/contractor or15
his/her immediate family has an investment;16
2. Any business entity in which the officer, employee, consultant/contractor17
or his/her immediate family is a director, officer, partner, trustee,18
employee, or holds any position of management; or,19
3. Any real property in which the officer, employee, consultant/contractor or20
his/her immediate family has a direct or indirect interest.21
B. USE OF CONTRACTORS 22
In accordance with Government Code, Section 1126, no designated employee 23
filing an Annual Statement shall accept money or gifts from any current 24
contractor providing facilities, grounds, or construction services to the District. 25
Designated employees are required to disclose on the Annual Statement any 26
money or gifts in any amount from any current contractor providing facilities, 27
grounds, or construction services to the District. For purposes of this section, a 28
‘current contractor’ refers to any business entity or individual including 29
contractors, suppliers, architects, attorneys, engineers, and insurers, providing 30
services related to the construction of facilities or grounds for the District during 31
the year covered by the Annual Statement. 32
C. PENALTIES 33
Any employee who shall make, participate in making, or in any way attempt to 34
use his or her relationship with the Cerritos Community College District to 35
influence a decision of the Cerritos Community College District in which he or 36
she knows or has reason to know he or she has a prohibited financial interest 37
shall be subject to discipline, including up to dismissal. 38
D. ACADEMIC DECISIONS 39
In the area of academic decisions, the Fair Political Practices Commission has 40
established certain specific exemptions from conflict of interest provisions which 41
are applicable to the Cerritos Community College District. Academic decisions 42
with respect to textbook utilization and other educational materials are also 43
subject to the District’s written guidelines for textbooks which appear in the 44
Faculty Handbook. The regulations for academic decisions adopted by the 45
California Fail Political Practices Commission, at Title 2 Code of the California 46
Code of Regulations (CCR), Section 18705, provide as follows: 47
Section 18705. Academic Decisions. 48
“(a) Except as provided in subsection (b), neither disclosure of financial 49
interests nor disqualification is required under Government Code, Sections 50
87100, 87302, or any Conflict of Interest Code, in connection with: 51
“(1) Teaching decisions, including the selection by a teacher of books or 52
other educational materials for use within his or her own school or 53
institution, and other decisions incidental to teaching; 54
“(2) Decisions made by a person who has teaching or research 55
responsibilities at an institution of higher education to pursue personally a 56
course of academic study or research, to apply for funds to finance such a 57
project, to allocate financial and material resources for such academic 58
study or research, and all decisions relating to the manner or methodology 59
with which such study or research will be conducted. Provided, however, 60
that the provisions of this subsection (2) shall not apply with respect to 61
institution- or campus- wide administrative responsibilities respecting the 62
approval or review of any phase of academic research or study conducted 63
at the institution or campus. 64
“(b) Disclosure shall be required under Government Code, Section 87302 65
or any Conflict of Interest Code in connection with a decision made by a 66
person or persons at an institution of higher education with principal 67
responsibility for a research project to undertake such research, if it is to 68
be funded or supported, in whole or in part, by a contract or grant (or other 69
funds earmarked by the donor for a specific research project or for a 70
specific researcher) from a nongovernmental entity, but disqualification 71
may not be required under Government Code, Sections 87100, 87302, or 72
any Conflict of Interest Code in connection with any such decision if the 73
decision is substantively reviewed by an independent c
ommittee 74
established within the institution.” 75
E. DISTRIBUTION OF THIS POLICY 76
Copies of this policy shall be distributed by the Human Resources Office to all 77
current and future employees. 78
See also BP/AP 2710 titled Conflict of Interest and BP 2712 titled Conflict of Interest 79
Code. 80
Office of Primary Responsibility: Human Resources 81
Date Adopted: December 10, 2008
(Replaces former Cerritos CCD Policy 5000.1)
INJURY & ILLNESS
PREVENTION PROGRAM
Cerritos College
11110 Alondra Blvd.
Norwalk, CA 90650
(562) 860-2451
Page 2
TABLE OF CONTENTS
Injury & Illness Prevention Policy .................................................................................................................. 3
Definitions .......................................................................................................................................................... 3
Responsibilities ................................................................................................................................................... 4
Plan Review......................................................................................................................................................... 5
Occupational Safety & Health Work Practices – Compliance .................................................................... 5
Communication .................................................................................................................................................. 6
Evaluation, Investigation, & Correction of Workplace Hazards ................................................................ 7
Employee Training ............................................................................................................................................ 9
Recordkeeping .................................................................................................................................................. 10
Reporting Job-related injuries/illness ........................................................................................................... 10
APPENDIX I ................................................................................................................................................... 11
Identification of District IIPP Coordinators
Page 3
INJURY AND ILLNESS PREVENTION POLICY
The District will develop and implement an Injury and Illness Prevention Program to meet its
obligations of maintaining a safe and healthful work place. The Cerritos Community College
District Board of Trustees, the District, and its management pledge to support this program and to
ensure that it remains a viable method of protecting all employees and all other site occupants, as
well as meet our compliance requirements.
DEFINITIONS
DISTRICT
The legal educational agency consists of Cerritos College.
WORKPLACE
References the area of operations to which an employee is assigned (i.e., Cerritos College or District
Services).
Page 4
RESPONSIBILITIES
The Injury and Illness Prevention Program (IIPP) Coordinator for the Cerritos Community College
District is the President/Superintendent. The President/Superintendent has designated the Risk
Manager as the IIPP District Coordinator and the Division Deans as the IIPP Site Coordinators
with site specific responsibility for the IIPP. The President/Superintendent is responsible for
ensuring that District policies and practices are implemented, employees are provided a safe and
healthful workplace, and that operations are in compliance with the Injury and Illness Prevention
Program and applicable federal, state, and local regulations and standards.
IIPP DISTRICT COORDINATOR
The Risk Manager is responsible for the IIPP and implementation of program requirements for the
District.
IIPP SITE COORDINATORS
The Division Deans are responsible for the IIPP and implementation of program requirements for
their divisions.
SITE MANAGER
The Administrators, Department Directors, and Managers are designated as site managers and are
responsible for ensuring that their direct reports and employees implement and follow the IIPP and
associated programs and practices required to meet all applicable regulatory requirements. The site
managers will be responsible for maintaining a safe and healthful workplace, conducting safety
inspections, and ensuring compliance with all Cal/OSHA and other applicable federal, state, and
local safety and health standards and regulations.
EMPLOYEES
Employees must comply with the provisions of the IIPP and health and safety regulations, promptly
report unsafe activities and conditions to management, and actively participate in safety and health
training and other related activities.
CONTRACTORS
Contractors must have their own IIPP and their program must complement the District’s IIPP.
Contractors must meet all regulatory requirements and actively participate in site health and safety
activities as required in contracts and purchase orders.
OTHERS UNDER THE PURVIEW OF THE IIPP
All others under the purview of this IIPP (e.g., associated student officers, student aides and hourly
employees) must comply with the provisions of the program and health and safety regulations,
promptly report unsafe activities and conditions to management, and actively participate in safety
and health training and other related activities.
VISITORS AND GUESTS
Visitors and guests must comply with site health and safety requirements and participate in IIPP
activities as required.
Page 5
PLAN REVIEW
The IIPP District Coordinator will be responsible for ensuring the IIPP is accessible via the
www.cerritos.edu website and it is reviewed at least once during the first year after implementation
and then at least annually, thereafter.
The review will be to ensure that the written plan is appropriate for the District at the time of the
review and for any anticipated future changes. The IIPP Site Coordinators will be required to
provide written notice to the IIPP District Coordinator. The IIPP District Coordinator will then
provide written notice to the President/Superintendent that the review was conducted and
communicate changes, suggested modifications, and improvements, if any.
OCCUPATIONAL SAFETY AND HEALTH WORK PRACTICES – COMPLIANCE
The President/Superintendent, through the IIPP District Coordinator and IIPP Site Coordinators,
will implement a system or systems to ensure that all employees comply with workplace safety and
health practices.
The system or combination of systems will include any one or combination of the following:
1. Training and retraining programs: training and retraining needs have been identified and
published in the annual schedule of safety and health training.
2. The IIPP procedure and updates pertaining to safety will be published annually.
3. Administrators and classified leadership will monitor ongoing pe
rformance and participation
as required in the IIPP through the performance appraisal process as identified in the
administrative procedures and collective bargaining agreements.
Employees found violating workplace safety practices or found jeopardizing the safety of
any other employee, student, or visitor shall be subject to disciplinary action in accordance
with the existing District policies, administrative procedures, and collective bargaining
agreements. Disciplinary action shall be taken for violations of management directives, rules,
regulations, work practices, or policies. Any action taken will not violate employee rights
under Cal/OSHA regulations and will be enforced in a non-discriminatory fashion.
4. Safety and health procedures and practices will be published and communicated to
employees.
Page 6
COMMUNICATION
Communication to employees and between employees and the District on matters relating to
occupational safety and health is an important aspect of ensuring the success of the District’s Injury
and Illness Prevention Program. Therefore, through the IIPP District Coordinator and the IIPP
Site Coordinators, the District will implement a system or combination of systems intended to
accomplish the following:
1. Provide a means for the District to communicate to employees, in a readily understandable
form, matters relating to occupational safety and health; and
2. Encourage employees to inform the District Facilities Department of workplace safety
hazards
The communication portion of this IIPP will consist of any one or combination of the following:
1. TRAINING AND RETRAINING PROGRAMS. Safety training and retraining classes
provide a forum for the discussion of specific and general safety, health, and compliance
best practices.
2. MEETINGS. Site managers will conduct safety meetings or staff meetings, which may
include the discussion of safety issues or specific safety topics. These meetings are intended
to discuss one or more safety items and encourage open discussions between employees and
management.
3. SAFETY COMMITTEE. The Safety Committee is considered an important part of the
overall system of communication. The recommended committee make-up may include
representatives from the following:
Administration
Maintenance/Operations
Students
Academic Staff
Classified Staff
Safety and Security/Campus Police
Faculty
Expert Consultants
The Safety Committee will ensure that the following requirements are met:
a. The committee meets regularly, but not less than quarterly.
b. Minutes or written records are prepared for each meeting showing the safety and
health issues discussed. These records shall be made available to all affected
employees through the use of postings, newsletters, or other appropriate written
Page 7
materials. Records of the meetings will be kept on file and be accessible via the
www.cerritos.edu website for at least 5 years.
c. Reports of safety inspections, investigations of occupational accidents, and causes of
any incident resulting in injury, illness, or exposure to hazardous substances are
reviewed. Where necessary or appropriate, the committee will submit suggestions to
management for the prevention of future incidents.
4. ANONYMOUS NOTIFICATIONS. Notifications can be made in open forums or
training sessions, as well as through inter-departmental mail sent to management,
supervisors, union representatives, or Human Resources. Site Managers will submit all
anonymous notifications to the Safety committee.
5. MISCELLANEOUS. When appropriate, the District may use written communications
such as inter-District memos, electronic media, envelope stuffers, newsletters, and workplace
postings to supplement the previously described systems and further communicate to
employees matters relating to workplace safety and health.
EVALUATION, INVESTIGATION and CORRECTION OF WORKPLACE HAZARDS
A major component in the effectiveness of the Injury and Illness Prevention Program depends on
the ability to properly identify, evaluate, and correct workplace hazards. The main system for
identifying and evaluating workplace hazards will be ongoing evaluations, inspections, and meetings.
The purpose of these inspections and meetings will be to identify and correct unsafe conditions and
work practices.
Workplace inspections will be scheduled and can be conducted on an as needed basis using the
following criteria:
An initial inspection when the program is first established;
An inspection of affected areas whenever a new substance, process, procedure, or piece of
equipment that potentially presents a new occupational safety and/or health hazard is
introduced to the workplace;
An inspection of affected areas whenever the management is made aware of a new or
previously unrecognized hazard; and
When occupational illnesses and injuries occur, the IIPP Site Coordinator or designee will
conduct the investigation.
1. ONGOING INSPECTIONS. The annual workplace inspection is an important part of
the overall inspection program. Site Managers are responsible for ensuring safety
inspections are conducted per schedule. These inspections will be conducted with the
following considerations:
Page 8
a. The IIPP Site Coordinator in conjunction with the Site Manager will designate
management personnel conducting the inspections.
b. Inspections may be accomplished using check-off forms or other means of
documentation.
c. Copies of the completed check-off forms or other documents will be distributed as
follows:
IIPP Site Coordinator
Site Manager
Safety Committee
2. ANNUAL INSPECTIONS. The District will use outside safety consultants to
supplement the in-house inspection program. Inspections by outside safety consultants will
be conducted annually. The party conducting the professional inspections must have
professional qualifications and safety expertise, e.g., Certified Safety Professional (CSP), a
professional member of the American Society of Safety Engineers (ASSE), or a registered
Professional Engineer (PE) in safety with demonstrated experience at educational
institutions and must carry liability insurance. Copies of consultant’s inspection reports will
be maintained at least 5 years at the District’s Business Office.
3. SAFETY ACTIVITIES. Job Safety Analysis (JSA), employee safety training, or issue
specific assessments (e.g., department ergonomic studies) may be used in lieu of or to
supplement the scheduled workplace inspections.
4. ACCIDENT INVESTIGATIONS. The injured employee’s immediate manager will
conduct the accident investigations to identify and correct unsafe conditions and practices.
These investigations will be conducted for all work-related injuries and illnesses resulting in
employees being unable to work.
5. CORRECTIONS OF UNSAFE OR UNHEALTHFUL CONDITIONS. Unsafe or
unhealthy work conditions, practices, or procedures shall be corrected in a timely manner
based on the severity of the hazards. Hazards shall be corrected according to the following
criteria:
a. When observed or discovered.
b. When an imminent hazard exists that cannot be immediately abated without
endangering employee(s) and/or property, all exposed employees, except those
properly trained or qualified to correct the existing condition, will be evacuated from
the area impacted.
c. Following an accident investigation or hazard assessment (e.g., JSA) when unsafe
acts or conditions are identified.
Page 9
d. When evidence of repeated unhealthful situation is documented and reported in
specific areas.
All such actions taken to correct hazards and corresponding dates of completion shall be
documented on the appropriate forms. The responsible Administrators, Deans, Directors,
and Managers shall be notified of unsafe conditions and corrective action recommended.
EMPLOYEE TRAINING
The IIPP District Coordinator and the IIPP Site Coordinators units will implement and maintain an
Occupational Safety and Health Training Program for their respective employees. The training
program is intended to train and instruct employees in general safety and health work practices, and
to provide instruction with regard to hazards specific or unique to each employee’s job.
The IIPP Site Coordinators shall ensure that all Site Managers are knowledgeable of the safety and
health hazards to which employees under their immediate direction and control may be exposed.
Employee training may include the following elements:
1. All employees will receive training and instruction when the Injury and Illness Prevention
Program is first established and when modifications and revisions are completed. All
employees will receive information on the IIPP at the time of hire.
2. All affected or potentially affected employees will receive appropriate safety training prior to
assignments, when potentially exposed to new hazards, when assigned new work tasks, or
when a new chemical/material, equipment, or process is introduced into the workplace.
3. Employees will receive refresher training when new or previously unrecognized hazards are
identified, when the District feels it is appropriate, or as mandated by regulatory
requirements.
4. Employees attending or receiving training mandated by this Program will sign attendance
sheets and actively participate in training.
5. Specific employee training will be determined/identified by the IIPP District Coordinator,
IIPP Site Coordinators, and the Site Managers in consultation with safety consultants. This
training will be designed to address department and task specific compliance and accident
prevention needs.
6. IIPP District Coordinator and District Workers’ Compensation Coordinators will receive
appropriate training to ensure compliance with OSHA regulations.
Page 10
RECORDKEEPING DUTIES
Records of hazard assessments, safety and hazard inspections, safety meetings, accident
investigations, and safety and health training for each employee will be maintained for at least 5
years.
The hazard assessments, health and safety inspections, and accident investigation records will
identify the person conducting the inspection/activity, any unsafe conditions or practices identified,
and the corrective action(s) taken to eliminate or control the hazard.
Health and safety training records shall include the name of the employees trained, date and type of
training provided, and the provider of the training.
Page 11
APPENDIX I
IDENTIFICATION OF PROGRAM MANAGERS
IIPP Coordinator President/Superintendent
IIPP District Coordinator Human Resources/Risk Management
IIPP Site Coordinators Instructional Dean, Business Ed/Humanities/Social Sciences
Instructional Dean, Fine Arts/Communications
Instructional Dean, Health Occupations
Instructional Dean, Liberal Arts
Instructional Dean, Physical Education/Athletics
Instructional Dean, Science, Engineering & Mathematics
Instructional Dean, Technology
Dean of Academic Affairs
Dean of Academic Success & Institutional Effectiveness
Dean of Admissions, Records & Services
Dean of Counseling
Dean of DSPS
Dean of Student Support Services
Dean of the Library, Special Programs & Services
Site Managers Exec Director of Foundation & Community Advancement
Director of Adult Education/Diversity Programs
Director of Advance Transportation Technology Project
Director of Career and Assessment Services
Director of Child Development
Director of Community Advancement
Director of Community Education
Director of Employment, Diversity & Legal Services
Director of Fiscal Services
Director of Foster & Kindship Care Educational Program
Director of Information Technology
Director of International Student Services
Director of Pathway Programs
Director of Physical Plant
Director of Public & Government Relations
Director of Purchasing
Director of Student Activities
Director of CalWORKS Services
Director or Research and Planning
Accounting Manager
Associate Dean of Student Health, Wellness & Veterans Services
Page 12
Budget Manager
Chief of Campus Police
EOPS Assistant Director
Facilities Manager
Manager of Information Technology
Operations Manager
Payroll Manager
PeopleSoft Database Administrator
Web Administrator
Cerritos College
Public Affairs
Procedure for a New Cerritos College Web
To req
uest a Cerritos College web:
1) Along with your dean or manager, request a new computer account from IT by submitting the
new computer account form found on the IT web, www.cerritos.edu/it
.
2) Request a new web from Samuel Chavez in Public Affairs at x2966 or schavez@cerritos.edu or
contact Ty Bowman at tbowman@cerritos.edu
and tell us your username or Cerritos email
address.
3) Set up a one-hour training appointment with Samuel Chavez to get started.
4) Refer to the Web Handbook, www.cerritos.edu/webhandbook
, to learn our standards,
understand your responsibilities as a web author and gain technical knowledge of how to use
the Cerritos Web Content Management System web authoring tool.
Th
e web administration team is part of the Public Affairs department. We are responsible for all aspects
of the college’s public information web. Internally, we provide tools and training to Cerritos College
employees to allow you to update web page content easily. We are available to assist you with your
web site during the week via telephone, email and in person. Appointments are scheduled in the
Innovation Center (LRC201) to meet and discuss any questions or concerns you may have so please
don’t hesitate to contact us.
As
a public institution, Cerritos College has mandates from the federal government and state of
California to follow Web accessibility guidelines also known as Section 508, www.section508.gov
. Every
employee has the responsibility to make sure that all pages and content associated with the Cerritos
College Web is accessible to persons with disabilities. The Cerritos College Board, President and
administrators have a long standing commitment to Web Accessibility which is seen as vital to student
success. Web content posted by any employee of the District that is used for college business is the
liability of Cerritos College no matter where the content resides. Web Administration is committed to
helping you create web pages that meet Web Accessibility guidelines and all Cerritos College web
standards.
Ou
r goal is to assist you in helping students at Cerritos College succeed in their academic pursuits by
providing tools and training that enable you to provide information to all students via the web. We
would like to thank you for your time and look forward to meeting and working with you.
Cerritos Community College District Procedure No. 3720
General Institution
AP 3720 COMPUTER AND NETWORK USE
1
References: 2
Education Code, Section 72400; 3
Government Code, Section 3543.1(b); 4
Penal Code, Section 502; 5
17 U.S.C., Sections 101 et seq.; 6
Cal. Constitution Article 1, Section 1; 7
Federal Rules of Civil Procedure, Rules 16, 26, 33, 34, 37, and 45 8
PREAMBLE 9
These standards and administrative procedures defining and governing acceptable and 10
unacceptable use will apply to anyone who uses any computer system, network system, 11
Internet connectivity or intranet site or other data processing resources provided by the 12
District. It is considered a violation of District policy to use the District’s network and/or 13
Internet access in such a way that it interferes with or is incompatible with the user’s 14
performance, duties, or responsibilities. 15
As a condition for receiving and exercising computing privileges, a user of District 16
computing systems must read, understand, and comply with the standards and 17
procedures outlined herein and to any further guidelines provided by the administrators 18
of each area and/or system. 19
Unacceptable use is prohibited and can become grounds for loss of computing 20
privileges, disciplinary action up to and including termination or expulsion and/or legal 21
actions under local, state and federal laws. 22
The District is committed to providing access to computing resources to all members of
23
its current student body, faculty, staff and members of the Board of Trustees and other 24
authorized community members. While the fullest possible open access to District 25
computing facilities and systems is consistent with the educational and service missions 26
of the District, such access to this valuable and vulnerable District resource is a 27
privilege. The District is responsible for securing its network and computing systems to 28
a reasonable degree against failure, loss of data, and unauthorized access, while 29
making them accessible to the largest possible group of authorized and legitimate users 30
and uses within the financial and educational constraints of the District. 31
PRIVILEGES 32
An individual user must respect the rights of other users, respect the integrity of the 33
systems he/she is using, and observe all relevant laws and regulations. 34
Users do not own either District computers or accounts, but rather are granted the use 35
of such computers and accounts. The District owns the computers and accounts and 36
grants individuals the privilege of using them. 37
District employees may apply for user IDs to utilize email and restricted Internet
38
services. Connectivity to the Internet from off-campus locations is not provided for by 39
the District. 40
RESPONSIBILITIES 41
Each user is held accountable for his/her actions while using District resources. By 42
using his/her District provided resources, each user acknowledges and agrees to abide 43
by and conform to the following: 44
Computers and networks are provided to support District related research, 45
instruction, learning, communication, distribution of scholarly information, and 46
administrative activities. 47
A user shall not attempt to modify any system or network or attempt to crash or 48
“hack” into District systems. A user shall not tamper with any software protections or 49
restrictions placed on computer applications or files to protect shared assets, assets 50
managed by others, or software or data not part of a learning or research program in 51
approved curriculum. Unless properly authorized, a user shall not attempt to access 52
restricted portions of any operating system or security software. Improperly 53
accessing or attempting to access confidential information concerning students or 54
employees is prohibited. A user shall not attempt to remove existing software or add 55
his/her personal software to District computers and systems unless authorized by 56
the Director of Information Technology or his/her designee. 57
Prior to the purchase and installation of new software or hardware, the authorizing 58
Dean/area manager should contact the Information Technology Department to verify 59
licensing restrictions and compatibility of new software with the computer(s) and the 60
network. 61
An authorizing Dean/area manager must also contact the Information Technology 62
Department to verify software accessibility for students with disabilities prior to the 63
purchase and installation of any new software or hardware for educational programs. 64
A user shall use only his/her designated computer account. An account is non-65
transferable: a user shall not use another individual’s ID, password or account. A 66
user should respect the privacy and personal rights of others and not access or copy 67
another user’s email, data or files without permission. A user is responsible for 68
his/her own computer account(s) and shall not allow others to use his/her 69
account(s). A user should take precautions, such as locking the computer on which 70
he/she is working when he/she is not able to physically control access, so that 71
others may not access his/her computer resources. A user should select a secure 72
password, one that cannot be found within the dictionary, or easily guessed. The 73
use of upper/lower case letters in conjunction with numbers in selecting a password 74
is highly recommended. 75
A user is responsible for using software and electronic materials in accordance with 76
copyright and licensing restrictions and applicable District policies. Both District 77
policies and the law expressly prohibit the copying of software in violation of their 78
copyrights. 79
INDIVIDUAL USER RIGHTS 80
An authorized user is entitled to due process rights as described in Board Policies, 81
Administrative Procedures and collective bargaining agreements. 82
The District will respect the exercise of academic freedom as described in Board Policy 83
and an individual user’s right to free speech provided that the exercise of such right 84
does not violate any existing District Board Policy, Administrative Procedure, local, state 85
or federal laws. Individual rights to free speech do not overrule or preclude the express 86
prohibition of harassment of individuals on or off campus. 87
The District and its authorized users shall respect individual ownership rights to 88
intellectual property, subject to existing District Board Policies, Administrative 89
Procedures and collective bargaining agreements. 90
Virtually no online activities or services guarantee absolute privacy. It is impossible for 91
the District to protect the privacy of email messages and other electronic files or 92
documents. A user should be aware that electronic mail, documents and files are not 93
entirely private and are more analogous to an open postcard than to a letter inside a 94
sealed envelope traveling through the U.S. mail. A user should exercise appropriate 95
care and caution. 96
The District cannot protect an individual against the receipt of material that may be 97
offensive to him/her. A user of District electronic computing is warned that he/she may 98
receive material that is offensive. Likewise, an individual who uses email or those who 99
place personal information on the Internet should know that the District cannot protect 100
an individual from an invasion of privacy. The District will make every reasonable 101
attempt to honor the privacy of an individual using the District’s computing resources 102
for District business within the guidelines of the Electronic Communications Privacy Act 103
(ECPA), which makes it illegal to intercept electronic communications on a public or 104
private network without proper authorization, and state and federal students records 105
laws including the Family Educational Rights and Privacy Act (FERPA), and the Health 106
Insurance Portability and Accountability Act (HIPAA). 107
The District reserves the right, for an extraordinary reason (e.g., basic system security, 108
the safety of the campus or of an individual member of the campus community, the 109
interception of suspected illegal or inappropriate activity), to access and monitor all files, 110
and Internet and email use. 111
APPROPRIATE USES OF DISTRICT COMPUTER RESOURCES 112
The District’s computing facilities and network systems are provided to support the 113
instructional, cultural, research, professional and administrative activities of the District. 114
An employee may use District computers and the network for union activities in 115
accordance with applicable collective bargaining agreements and policies and 116
procedures governing the use of District equipment. A user is required to behave in a 117
responsible, ethical and legal manner and to follow this procedure and existing Board 118
Policies, Administrative Procedures and local, state and federal laws. 119
Individual divisions or areas within the District may define additional conditions of use 120
for information resources under their control. These statements must be consistent with 121
this overall procedure but may provide additional detail, guidelines and/or restrictions. 122
PROHIBITED USES OF COLLEGE COMPUTER RESOURCES 123
Copyright/License Infringement/Mass Mailings 124
A user may not participate in any activities knowingly and/or carelessly that have the 125
potential to interfere with or disrupt network users, services, or equipment. The 126
distribution or “forwarding” of spam or unsolicited advertising is strictly prohibited. The 127
District equipment may not be used to violate copyright laws or license agreements. No 128
one may inspect, change, copy or distribute proprietary data, programs, files, disks or 129
software without the proper authority. The prohibited transmission of copyrighted 130
material is forbidden without the express written authorization of the copyright holder. 131
Computer software protected by copyright must not be copied into, away from, or with 132
the use of campus computing facilities, except as permitted by law or by the terms of 133
the copyright. This means that such computer software may only be copied in order to 134
make back-up copies. The number of copies and distribution of copies may not be 135
done in such a way that the number of simultaneous users in a department exceeds the 136
number of original copies purchased by that department unless concurrent licensing 137
applies. 138
Defamation/Libel/Slander 139
Creating or transmitting any false statement that causes injury to an individual’s 140
reputation is strictly prohibited. Any user creating or transmitting defamatory statements 141
shall have sole liability for any damages resulting from such defamatory statement. Any 142
user may also be subject to the District disciplinary procedures for such action. 143
The user agrees never to attempt to transmit, or cause to be transmitted, any message 144
in which the origination is deliberately misleading. 145
Commercial and Political Use 146
Commercial use of the District computing systems for personal gain is prohibited. Use 147
for commercial and illegal purposes is unacceptable (e.g. inappropriate mass mailing or 148
“spamming”). This is in direct violation of the Cenic policy under which the District 149
obtains its access to the Internet. (See section 10 of the procedure.) 150
Personal use may be restricted if the resources consumed interfere with equitable 151
access by other users and the utilization of the system for school business purposes. 152
Direct marketing of personal products and services of any kind is prohibited. 153
Transmitting any unsolicited advertising, promotional materials or other forms of 154
soliciting is prohibited without authorization from District administration. 155
Links to external sites that market required or recommended instructional materials are 156
allowed only if such links appear in the context of other required and recommended 157
instructional materials, more than one source for such materials is listed, and the 158
materials are available at the campus bookstore and shelved with instructional items. 159
References on individual web pages to external sites that market non-instructional 160
products and services such as consulting services, etc. are allowed only in the context 161
of a résumé listing. 162
Links to external sites using direct marketing language such as “consulting services” is 163
not permitted. 164
The District is a non-profit, tax-exempt organization and, as such, is subject to specific 165
local, state and federal laws regarding sources of income, political activities, use of 166
property and similar matters. District information resources must not be used for 167
partisan political activities that urge the support or defeat of any ballot measure or 168
candidate, or where such use would otherwise be prohibited by local, state, or federal 169
laws, Board Policy or Administrative Procedures. 170
Use of District Computing System and Resources
171
Creating, accessing, transmitting, uploading, downloading, printing, or storing sexually
172
explicit, obscene, pornographic, indecent, or lewd material or messages is prohibited, 173
except to the extent that such actions are in furtherance of research or a project that is 174
reasonably and legitimately related to an employee’s position or a student’s coursework. 175
Processing, transmitting, downloading, or publishing any material in violation of any
176
local, state or federal law is prohibited, including but not limited to the following: 177
1. Creating, accessing, transmitting, uploading, downloading, printing, or178
storing sexually explicit, obscene, pornographic, indecent, or lewd material or179
messages, except to the extent that such actions are in furtherance of research 180
or a project that is reasonably and legitimately related to an employee's position 181
or student's coursework. 182
2. Creating, accessing, or transmitting material or messages that could be 183
considered discriminatory, offensive, threatening, harassing, intimidating, vulgar, 184
profane, or violent. 185
3. Creating, accessing, or transmitting material or messages that could be 186
considered defamatory. 187
4. Violating any state or federal statute or District policy or regulation. 188
5. Creating, forwarding, or exchanging spam, chain letters, mass postings, 189
solicitations, or advertising. 190
6. Using District computers, networks, or Internet access for partisan political 191
activities that urge the support or defeat of any ballot measure or candidate, or 192
where such use would otherwise be prohibited by local, state or federal laws, 193
Board Policy or Administrative Procedures. 194
7. Unauthorized use, duplication, or transmission of copyrighted material or other 195
intellectual property (including software license agreements). 196
8. Accessing or communicating another individual's password, personal 197
identification number, or other information or files without permission. 198
9. Using District computers, networks, or Internet access for illegal or unethical 199
activities or unauthorized purposes. 200
10. Using District computers, networks, or Internet access for private or personal 201
financial gain, or in connection with non-District consulting, business, or 202
employment. 203
11. Gaining, attempting to gain, or instructing others as to how to gain unauthorized 204
access to District computers, networks, or Internet access. 205
12. Obscuring or instructing others as to how to obscure the true identity of a user. 206
13. Attempting to modify, reconfigure, add, or remove computer equipment, software, 207
hardware, or peripherals without proper authorization. 208
14. Downloading software onto District computers, hardware, or equipment, or 209
through the District network or Internet connectivity without proper authorization. 210
15. Vandalizing, damaging, disabling, or destroying District property or the property 211
of another individual or organization. 212
16. Knowingly engaging in any activity harmful to the District's computers, networks, 213
or Internet access, or to the security or integrity of such systems. 214
17. Creating, installing, or propagating a computer virus, worm, or other 215
surreptitiously destructive program on any District computer, network, or via 216
District Internet access, regardless of whether any demonstrable harm results. 217
18. Circumventing or subverting any District computer, network, or Internet security 218
measures or logon procedures. 219
19. Violating any software license or copyright, including copying, redistributing, 220
storing, or transmitting copyrighted software without the written authorization of 221
the software owner. 222
20. Sending any fraudulent electronic communication. 223
21. Willfully interfering with another's authorized computer, network, or 224
Internet usage. 225
22. Connecting any computer, hardware, or equipment to the District's network, 226
Internet connection, or peripherals without authorization and/or without 227
confirmation that the computer/hardware/equipment meets the technical and 228
security standards set by the District. 229
23. Unauthorized distribution of District data and/or proprietary information. 230
24. Performing any activity that could cause the loss or corruption of, or prevent 231
rightful access to District data or information, or which will interfere with the 232
normal operation of computer, networks, Internet connectivity, or other 233
resources. 234
25. Creating, accessing, or participating in online gambling. 235
26. Non-work related or coursework-related uses such as playing games or 236
participating in dating services. 237
27. Uses in the furtherance of academic dishonesty. 238
28. Forging, fraudulently altering or falsifying, or otherwise misusing District records 239
or documents. 240
Viruses and “Hacking” 241
A user may not upload, transmit, intentionally download, or participate in any manner in 242
the creation, promulgation, publication or use of computer viruses on District resources 243
not designated for such research purposes. A user may not knowingly or carelessly 244
introduce or distribute (i.e. by “forwarding”) any invasive or destructive programs (such 245
as viruses, worms, Trojan Horses) in the District computing system. 246
Engaging in any form of “hacking” (i.e. gaining illegal access) while using the District 247
computing or network systems is prohibited. “Hacking” includes, but is not limited to, 248
gaining access to restricted computer systems/sites and/or viewing, copying, 249
downloading or altering the computer programs, data files, and other materials 250
contained therein. 251
Improper Use of Private Passwords and Security Devices 252
A user shall use only his/her designated computer account(s) or an appropriate 253
authorized “generic” account to which he/she is entitled to access. A user is 254
responsible for his/her computer account(s) and shall not allow others to use his/her 255
computer account(s). Individual password security is the responsibility of each user. A 256
user may not use any passwords, recognition codes, security access information, or 257
physical locking devices such as locks on any part of the computing system without the 258
District’s prior written consent. A user must inform the Director of Information 259
Technology in writing all electronic security devices the user wishes to use prior to using 260
them and provide electronic keys, passwords, access codes and/or other security 261
information or materials to permit the District to obtain access to the user’s secured 262
areas. The District reserves the right to remove any such device at any time at the 263
District’s discretion. 264
Users should always maintain their own backups of their protected data as the removal 265
of any private protection systems, of which the District was not aware, could result in 266
unrecoverable data loss. It is a violation for users to protect any assets to which the 267
District has an interest with such systems if the keys are not placed in a proper, 268
authorized escrow with the Director of Information Technology. 269
System Alterations 270
Modifying or altering the computing system (except in approved research or for 271
instructional purposes) in any way is prohibited. This includes but is not limited to 272
altering or attempting to alter system software or hardware configurations on either 273
network systems or local computing devices; installing unauthorized software programs 274
on District local computing devices or network systems and/or using such programs; 275
and/or attempting to circumvent local or network system security measures. 276
Modification and alteration of the computing system does not include ordinary 277
operations involving the saving and deleting user generated files that are created in 278
furtherance of District business or educational purposes. 279
Nondiscrimination/Discriminatory Harassment 280
A user has the right to be free from any conduct connected with the use of the District’s 281
computer and network resources which discriminates against any person on the basis 282
of the categories contained in BP 3410 titled Nondiscrimination. Using the District 283
computer and network resources to transmit any message, create any kind of 284
communication, or store information which violates District policies or procedures 285
regarding discrimination or harassment is prohibited. 286
Unauthorized Use/Failure to Follow Procedures 287
Use of the computer and network systems is a privilege extended to students and 288
employees and not a right. An employee user will provide acknowledgement of receipt 289
of the terms and conditions in Administrative Procedure 3720 to the District before the 290
District will provide use privileges. The written acknowledgement will be retained in the 291
employee’s personnel file. A student user will be provided notice of the terms and 292
conditions of this Administrative Procedure through the class schedules, the District 293
website and applicable instructional materials. 294
If substantial amendments, modifications and/or a revocation of the terms and
295
conditions of this Administrative Procedure are made, an employee user will be required 296
to provide a written acknowledgement of receipt of notice of these changes to the 297
Human Resources Office within a reasonable period of time, not to exceed 60 days. 298
Failure to comply with this requirement may result in restriction from computer privileges 299
until the District has received the written acknowledgement. A student user will be 300
notified through the class schedule, the District website and applicable instructional 301
materials. 302
Each employee or student user is responsible for his/her authorized use of the 303
computers and network as described in this Administrative Procedure. Unauthorized 304
use of the computer and/or network system includes: 305
Failure to follow the procedures set forth in this procedure and/or306
Engaging in the activities described in Section 6, Prohibited Uses of District307
Computer Resources, of this procedure and/or308
Use of the computer and/or network system in a manner which violates local,309
state, or federal laws, Board Policy, Administrative Procedures or reasonable310
rules and regulations of the District or a department and/or311
Use of the computing and/or network system in a manner which damages or312
harms any person and/or the property of the District.313
An employee user who engages in unauthorized or prohibited use of the computer 314
and/or network system may lose computer privileges and/or may be subject to 315
disciplinary action up to and including termination from employment. A student user 316
who engages in unauthorized or prohibited use of the computer and/or network system 317
may lose computer privileges and/or may be subject to disciplinary action up to and 318
including suspension or expulsion. 319
If allegations of unauthorized or prohibited use are made against a user and the District 320
pursues disciplinary action, disciplinary procedures in this action will follow the 321
applicable Education Code sections and Board Policies. 322
If a user engages in unauthorized or prohibited use which constitutes a violation of local, 323
state, or federal laws, such violation will be reported to the appropriate law enforcement 324
agency for prosecution as deemed appropriate by the law enforcement or regulatory 325
agency. 326
Additional Guidelines
327
The District retains the right to revoke, amend, or change the provisions of this 328
Administrative Procedure for Computer and Network Use. However, any such changes 329
to these procedures will first be reviewed by the Information Technology Standards 330
Committee and the college community shall be informed of such changes through 331
email. 332
Any defects discovered in computing and network system accounting or system security 333
must be reported promptly to the Director of Information Technology so that steps can 334
be taken to investigate and solve the problem. 335
Disclosure
336
A user should be aware that he/she does not have an expectation of privacy in the use 337
of District computing and network resources. The District reserves the right to monitor 338
all use of District computer and network system to assure compliance with these 339
procedures. The District will only exercise this right for legitimate District purposes, 340
including but not limited to ensuring compliance with this procedure and the integrity 341
and security of the computing system. 342
A user is advised that there is the possibility of unintended disclosure of
343
communications. A user is advised that it is possible to retrieve information entered on 344
or transmitted via computer and communication systems, even if a user deletes such 345
information. 346
The California Public Records Act (Government Code, Sections 6250 et seq.) includes 347
computer transmissions in the definition of “public records” and communications made 348
on the District network or computing system which is not defined by law as exempt must 349
be disclosed if requested by a member of the public. 350
Computer transmissions and electronically stored information may be discoverable in 351
litigation. 352
“Cenic” Policy
353
Cenic is the District’s Internet Service Provider (ISP). District faculty, staff and students 354
are users of the services provided by Cenic and, therefore, must agree to abide by all 355
policies established by Cenic for the use of its network. The latest revision of the Cenic 356
policy is available for viewing at www.cenic.org which may be accessed by using the 357
“Network” tab and selecting “Policies.” This Cenic policy is available as a reference for 358
faculty, staff and students to review. 359
Offices of Primary Responsibility: Vice President, Business Services 360
Human Resources 361
Date Approved: November 26, 2007
(Replaces former Cerritos College Policy 3032
(4400))
PERSONAL SAFETY
ON CAMPUS
Cerritos College
Annual Security Report - 2014
Page 1 of 12
THE ANNUAL SECURITY REPORT
The Campus Police department prepares this report to comply with the Jeanne Clery Disclosure of Campus
Security Policy and Crime Statistics Act. The full text of this report can be located on our web site at
www.cerritos.edu/securityreport.
Copies of this report may also be obtained at the Campus Police station located
on the south side of campus at 11090 New Falcon Way, Cerritos CA or by calling (562) 924-3618. Notification of
the availability of this report is provided to students and potential students in the Class Schedule each semester.
Students are also notified via email of the availability of this report by October 1
st
of each year. Faculty and staff
receive similar notification via interoffice mail by October 1
st
of each year.
ABOUT THE CERRITOS COLLEGE POLICE DEPARTMENT
The Board of Trustees has established the Cerritos College Police Department (CCPD), which has primary
responsibility for patrolling District property. The Police Department’s jurisdiction includes other grounds or
properties owned, operated, controlled, or administered on behalf of the Cerritos Community College District as
outlined in the Education Code, Section 72330. CCPD is committed to the safety and security of all students, staff,
and faculty, as well as others visiting Cerritos College. CCPD is
responsible for patrolling District grounds, facilities,
and parking lots to protect persons and property and enforce applicable laws and ordinances.
CCPD police officers have complete police authority to apprehend and arrest anyone involved in illegal acts,
pursuant to California Penal Code Section 830.32 and Education Code Section 72330. Having met all state
standards for selection and training, the officers have authority equal to a municipal police officer or county deputy
sheriff.
CCPD personnel work closely with local, state, and federal police agencies and have direct radio communication
with the Los Angeles County Sheriff’s Department as well as other local, state, federal, and military agencies which
participate in the Los Angeles Regional Tactical Communication System (LARTCS). CCPD is also part of the State
of California 911 Emergency System.
In addition to police officers, CCPD employs Police Cadets who patrol the campus on foot and by bicycle. While not
police officers, Cadets each have radio contact with CCPD and can summon assistance when necessary.
Cerritos College has a formalmemorandum of understanding (MOU) with the Los Angeles County Sheriffs
Department for its assistance with incidents that require resources not available on-site. This agreement also
clarifies operational responsibilities for investigations of Part I violent crimes and delineates the specific
geographical boundaries of each agencys operational responsibility. This written agreement is public record and is
made available for inspection
by members of the public upon request to the Chief of the Cerritos College Police
Department. Resources from other local, state and federal agencies are also available for incidents requiring
special personnel or equipment.
REPORTING CRIMINAL ACTIVITY
Members of the District, guests and the general public are strongly encouraged to immediately report all crimes and
public safety related incidents to the Campus Police Department (AP §3515). Crimes should be reported regardless
of the victim’s desire for prosecution to ensure inclusion in the annual crime statistics and to aid in providing timely
safety warnings to the community, when appropriate.
The Cerritos College Police Department is staffed 24 hours a day, every day. A person may report any criminal
activity or suspected criminal activity or any other emergency at any time, day or night, by calling the Police
Department. They can be reached by calling (562) 860-2451, ext. 2325 for routine inquiries or, in case of
emergency, by dialing 911 from any campus extension or pay phone on campus. There are also Emergency
Phones located throughout the campus which dir
ectly dial the Police Department. Emergency calls can also be
made via cell phone by dialing (562) 402-3674. Reports may be made in person at the Police Department, which is
located on the south side of campus at the 11090 New Falcon Way, Cerritos CA 90703.
All CCPD incident reports will be investigated as appropriate and those with sufficient information to warrant
Page 2 of 12
criminal filing will be submitted to the District Attorney’s office for consideration. Reports involving students in
violations of the law or the Student Standards of Conduct are forwarded to Office of Student Conduct and
Grievance for review and potential action.
OFF-CAMPUS CRIMINAL ACTIVITY
Cerritos College does not have off-campus student organizations. Crimes which occur at off-campus District
approved events such as athletic competitions should be reported to the law enforcement agency with jurisdiction
over the area the crime takes place.
CONFIDENTIAL REPORTING
If you are the victim of a crime but do not want to pursue action within the criminal justice or college system, you
may still want to consider making a confidential report. With your permission, the Vice-President of Human
Resources or a designee of can file a report on the details of the incident without revealing your identity. The
purpose of a confidential report is to comply with your wish to keep the matter confidential, while taking steps to
ensure the future safety
of yourself and others. With such information, the college can keep an accurate record of
the number of incidents on campus, determine where there is a pattern of crime with regard to a particular location,
method or assailant, and alert the campus community to potential danger. Reports filed in this manner are counted
and disclosed in the annual crimes statistics for the institution.
On-campus counselors and mental health professionals are encouraged to inform persons they are counseling of
the procedures to report crimes on a voluntary, confidential basis for inclusion in the annual crime statistics.
DISCLOSURES TO ALLEGED VICTIMS OF CRIMES OF VIOLENCE OR NON-FORCIBLE SEX OFFENSES
Cerritos College will, upon written request, disclose to the alleged victim of a crime of violence, or a non-forcible sex
offense, the results of any disciplinary hearing conducted by the college against the student who is the allege
perpetrator of the crime or offence. If the alleged victim is deceased as a result of the crime or offence, the college
will provide the results of the disciplinary hearing to the victim’s next of kin, if so requested.
TIMELY SAFETY WARNINGS
The District publishes “timely safety warnings” to the campus community any time a situation arises, either on or off
campus that, in the judgment of the President/Superintendent or designee, represents an ongoing or continuing
threat to students and employees. These warnings are disseminated by the Campus Police department in a timely
manner so as to aid in the prevention of similar crimes. (See Board AP §3515) Warnings will be issued through the
college e-mail system to s
tudents, faculty, staff and the campusstudent newspaper “Talon Marks”.
In the event of circumstances that could pose an immediate threat to the community and individuals, the Campus
Police department may also alert the community via text messaging utilizing Nixle and post a notice on the
electronic bulletin board accessible at www.cerritoscollege.us.
Copies of the notice are also posted at the entrances
to each building.
Anyone with information warranting a timely safety warning should report the circumstances to the Campus Police
Department, by phone at (562) 924-3618 or in person at the Campus Police station located on the South side of
campus at 11090 New Falcon Way, Cerritos CA 90703.
CRIME PREVENTION AND AWARENESS
Cerritos College enjoys a crime rate much lower than that of the surrounding area, but no community can be totally
risk-free in today’s society. The campus police department recognizes that safety on campus is everyone’s concern
and partners with students, staff and faculty in creating an atmosphere that is safe and encourages learning.
Working together with Student Government, Staff and Faculty groups and various clubs on campus, the police
department strives to provide
education while identifying specific concerns of the campus community.
Page 3 of 12
EDUCATION
Periodically throughout the year, CCPD officers, in cooperation with other campus departments and student clubs,
present crime prevention awareness sessions on sexual assault, theft and vandalism, as well as educational
sessions on personal safety.
In the last year, CCPD has provided almost a dozen training sessions on Emergency Preparedness and Disaster
Response to the campus community. This was done in conjunction with a complete rewrite of the District’s
Emergency Operation Plan and campus wide drills to test the new plan. Efforts to educate the community will
continue, along with expanded, multi-agency drills.
The Campus Police department has made focused efforts to educate and inform the campus community about its
number one crime problem, the theft of unattended property. By using various media outlets on campus and
through the distribution of information cards in areas attractive to thieves, the police department has increased
awareness and solicited the help of campus members in protecting personal property.
A common theme of all awareness and crime prevention programs is to encourage students and employees to be
aware of their responsibility for their own security and the security of others.
In addition to seminars, information is disseminated to students and employees through crime prevention
awareness fliers, security alerts, and articles in the campus and student newspapers.
PREVENTION
In addition to routine vehicle patrol, campus police officers and police cadets participate in bicycle patrol, allowing
better accessibility by students as well as more effective patrol of inner portions of the campus.
Crime prevention programs on personal safety and theft prevention are sponsored by various campus
organizations throughout the year. CCPD personnel facilitate programs for students, faculty and new employees
providing a variety of educational strategies and tips on how to protect themselves from sexual assault, theft and
other crimes.
At least once a year, the police department and members of the student government team up for a “safety walkof
the campus. These safety walks supplement ongoing efforts to evaluate areas such as lighting, landscaping,
building access, and emergency phones to best increase security.
The department provides an escort service 24 hours a day, 7 days a week. In addition, personnel are available to
assist with dead car batteries or keys locked in cars.
SAFETY TIPS
Stay alert and be aware of your surroundings. Know what is typical and what is not.
Report all crimes and suspicious activity to Campus Police immediately.
Avoid walking alone after dark. Make arrangements to travel with friends along a well-lit route, or request
an escort from Campus Police.
Most crimes on campus are thefts of unattended property. Do not leave purses, backpacks, books, etc.
unattended, even for a minute.
Know the location of Emergency Phones and Pay Phones in the areas you frequent.
Never leave valuables visible from outside your vehicle. Lock all property including books, purses and
backpacks in your trunk or take them with you.
Lock your office door if working after hours
Let others know where you are going, especially if you might be there alone.
If you are uncomfortable, go to where there are other people.
Headphones can eliminate your ability to be aware of your surroundings.
Move confidently at a steady pace and make eye contact with people.
Page 4 of 12
Keep keys in hand when moving to a vehicle.
Keep windows and doors locked.
Check the interior of a vehicle before getting in.
Go to the nearest open business or police station if you are being followed.
SAFETY POLICIES
The Cerritos College Board of Trustees has adopted numerous policies addressing safety issues on campus. Some
of these include:
SECURITY OF AND ACCESS TO FACILITIES
During business hours, the District will be open to students, employees, contractors, and community members.
During non-business hours, access to all District facilities is by key, if issued, or by admittance via the Campus
Police Department. In the case of periods of extended closing, the District will admit only those with prior written
approval to all facilities. Cerritos College does not have student housing.
Some facilities may have individual hours, which may vary at different times of the year. In these cases, the
facilities will be secured according to schedules developed by the department responsible for the facility.
Emergencies may necessitate changes or alterations to any posted schedules. Areas that are revealed as
problematic will have regular periodic security surveys. The Vice Presidents of Student Services and Business
Services, and managers from the Campus Police Department, Facilities Department, and other concerned areas
review these results. These surveys examine security issues such as landscaping, locks, alarms, lighting, and
communications. Additionally, the Director of Physical Pl
ant and Construction Services, and the Chief of Campus
Police co-chair the District Committee on Safety which consists of representatives from the various constituencies
on campus and meets on a monthly basis to discuss issues of pressing concern. (AP §3501)
WEAPONS
Firearms, knives, explosives, or other dangerous objects, including but not limited to any facsimile
fir
earm, knife, or
explosive, are prohibited on all District grounds, except as authorized by law.
ALCOHOL AND ILLEGAL DRUG POSSESSION, USE AND SALE
The possession, sale or the furnishing of alcohol on campus is governed by California state law and these
procedures. The possession, sale, consumption or furnishing of alcohol is controlled by the California Department
of Alcohol and Beverage Control. However, the enforcement of alcohol laws on-campus is the primary responsibility
of the Campus Police Department. The campus has been designated “Drug free” and only under certain
circumstances is the consumption of alcohol permitted. The po
ssession, sale, manufacture or distribution of any
controlled substance is illegal under both state and federal laws. Such laws are strictly enforced by the Campus
Police Department. Violators are subject to disciplinary action, criminal prosecution, fine and imprisonment. It is
unlawful to sell, furnish or provide alcohol to a person under the age of 21. The possession of alcohol by anyone
less than 21 years of age in a public place or a place open to the public is illegal.
It is also a violation of this policy
for anyone to consume or possess alcohol in any public or private area of campus without prior District approval.
Organizations or groups violating alcohol or substance policies or laws may be subject to sanctions by the District.
Alcoholic beverages on campus are permitted if:
The alcoholic beverage is for use in connection with a course of instruction, sponsored dinner or meal
demonstration given as part of a culinary arts program, and the instructor or individual has been authorized
to acquire, possess, use, sell, or consume it by the President/Superintendent;
The alcoholic beverage is possessed, consumed or sold during a special event, which is sponsored by the
Cerritos College Foundation and authorized by the President/Superintendent, where the principal
attendees are members of the general public or invited guests and not students;
Page 5 of 12
DRUG AND ALCOHOL FREE ENVIRONMENT AND DRUG AND ALCOHOL ABUSE PREVENTION
PROGRAM
The District is committed to providing its employees and students with an alcohol and drug-free
campus and workplace environment. It emphasizes prevention and intervention through education.
PREVENTION AND INTERVENTION PROGRAMS
The District provides education and maintains programs and services designed to aid students,
employees and their families in receiving assistance for alcohol and/or drug abuse problems.
Included in these educational and assistive programs and services are:
Notification of the dangers of drug use and dependency in the class schedule;
Mental health services provided to students through the Student Health Services; and
An Employee Assistance Program (EAP) for employees and their families:
ALCOHOL AND DRUG PROHIBITIONS
The unlawful manufacture, distribution, dispensing, possession, or use of alcohol or any controlled
substance is prohibited on District property, during District-sponsored field trips, activities or
workshops, and in any facility or vehicle operated by the District.
Violation of Board Policy 3550, Drug and Alcohol Free Environment and Drug and Alcohol Abuse
Prevention Program, will be addressed by the District. The District will take appropriate action
designed to address each specific violation, which may include, but is not limited to:
Termination of employment,
Expulsion,
Referral to Campus Police or other law enforcement agency for prosecution as permitted by law
Mandatory participation in an alcohol or drug abuse assistance or rehabilitation program
The Campus Police department vigorously enforces Federal and State underage drinking laws as well
as Federal and State drug laws.
EMERGENCY RESPONSE AND EVACUATION ROCEDURES
General information about the emergency response and evacuation procedures for the District is
publicized each
year as part of the District’s Clery Act compliance efforts and that information is
available at www.cerritoscollege.us.
All members of the campus community are notified on an annual basis that they are required to notify
the Campus Police Department of any incident on campus that involves a significant emergency or
dangerous situation that may involve an immediate or ongoing threat to the health and safety of
students and employees on campus. The Campus Police Department has the responsibility of
responding to, and summoning the necessary resources, to mitigate, investigate, and document an
y
situation that may cause a significant emergency or dangerous situation. In addition, Campus Police
has a responsibility to respond to such incidents to determine if the situation does in fact, pose a threat
to the community. If so, federal law requires that the institution immediately notify the campus
community or the appropriate segments of the community that may be affected by the situation.
Upon confirmation or verification by the District that a legitimate emergency or dangerous situation
involving an immediate threat to the health or safety of students or employees occurring on campus,
the District will determine the content of the message and will use some or all of the systems
described below to communicate the threat to the campus community or to the appropriate segment
of the community, if the threat is limited to a particular building or segment of the population. The
District will, without delay
, take into account the safety of the community, determine the content of the
Page 6 of 12
notification and initiate the notification system, unless issuing a notification will, in the judgment of the
first responders (including, but not limited to Campus Police), compromise the efforts to assist a victim
or to contain, respond to, or otherwise mitigate the emergency.
In the event of a serious incident that poses an immediate threat to members of the campus community,
the District has various systems in place for communicating information quickly. Some or all of these
methods of communication may be activated in the event of an immediate threat to the campus
community. These methods of communication include network emails, emergency text messages that
can be sent to a phone or Personal Digital Assistant (individuals can sign up for this service on the
District w
ebsite), public address system, phone calling trees, District website and emergency
messages that scroll across display screens in campus buildings. The District will post
updates during a critical incident on the District website at
www.cerritos.edu. Individuals can
call the District’s recorded information telephone line at (562) 860-2451 for updates. Cerritos College
students, staff, faculty and others can sign up for emergency text message alerts at
www.cerritoscollege.us or text keyword "CCALERTS" to 888777 from their mobile phones.
The District’s Director of Public & Governmental Relations will be responsible for the dissemination of
emergency information to the larger community through media alerts.
TESTING EMERGENCY RESPONSE AND EVACUATION PROCEDURES
An evacuation drill is coordinated by the Campus Police Department at least once per year for all
facilities on campus. Students learn the locations of the emergency exits in the buildings and are
provided guidance about the direction they should travel when exiting each facility for a short-term
building evacuation.
Evacuation drills are monitored by the Campus Police Department and District administration to
evaluate egress and behavioral patterns. Reports are prepared by participating departments which
identify deficient equipment so that repairs can be made immediately. Recommendations for
improvements are also submitted to the appropriate departments and offices for consideration.
The District conducts numerous announced and unannounced drills and exercises each year and
conducts follow- through activities designed for assessment and evaluation of emergency plans and
capabilities. Campus Police and District administration coordinate announced and unannounced
evacuation drills at least once per year, as described above, to test the emergency response and
evacuation procedures, and to assess and evaluate the emergency evacuation plans and
capabilities.
For each test conducted, Campus Police will document a description of the exercise, the
date, time, and whether it was announced or unannounced. The District will publish a summary of its
emergency response and evacuation procedures in conjunction with at least one drill or exercise each
calendar year.
In the event of an emergency, natural disaster or the occurrence of a hazardous condition the District
will activate its plan and procedures to protect and govern employees, students, visitors, and children
in childcare programs on campus and/or in district-owned or operated facilities. The District shall
maintain an emergency management team to aid in the creation, maintenance, updating, and
implementation of its emergency plan and procedures.
SEXUAL ASSAULT PREVENTION AND RESPONSE
Any sexual assault or physical abuse, including, but not limited to, rape, domestic violence, dating
violence, sexual assault, or stalking, as defined by California law, whether committed by an employee,
student, or member of the public, occurring on District property, in connection with all the academic,
educational, extracurricular, athletic, and other programs of the District, whether those programs take
place in the District’s facilities or at another location, or on an off-campus site or facility maintained by the
District, or on grounds or facilities maintained by a student organization, or at a District-sponsored activity
on non-District property is a violation of District policies and regulations and is subject to all applicable
Page 7 of 12
punishment, including criminal procedures and employee or student discipline procedures. (Also see BP
5500 titled Standards of Conduct and AP 5520 titled Student Discipline Procedures.)
“Sexual assault” includes but is not limited to, rape, forced sodomy, forced oral copulation, rape by a
foreign object, sexual battery, or threat of sexual assault.
“Dating violence” means violence committed by a person who is or has been in a social relationship of a
romantic or intimate nature with the victim.
“Domestic violence” includes felony or misdemeanor crimes of violence committed by:
a current or former spouse of the victim;
by a person with whom the victim shares a child in common;
by a person who is cohabitating with or has cohabitated with the victim as a spouse;
by a person similarly situated to a spouse of the victim under California law; or
by any other person against an adult or youth victim who is protected from that person’s acts
California law.
“Stalking” means engaging in a course of conduct directed at a specific person that would cause a
reasonable person to fear for his or her safety or the safety of others, or to suffer substantial emotional
distress.
The District has established a Crisis Assessment, Intervention and Response (CAIR) team on campus.
CAIR consists of representatives from Counseling, Student Health and Wellness Services, the Office of
Student Conduct and Grievance, Disabled Students Programs and Services, and Campus Police. CAIR,
with the assistance of outside experts in sex offense education, educates the campus community about
sexual assaults, domestic violence, dating violence and stalking through on-campus training programs.
Literature on these matters, risk reduction and District response is available through Student Health and
Wellness Services and Campus Police.
If you are a victim of a sexual assault on campus, your first priority should be to get to a place of safety.
You should then obtain necessary medical treatment. The Campus Police Department strongly
advocates that a victim of sexual assault report the incident in a timely manner. Time is a critical factor
for evidence collection and preservation. An assault should be reported directly to Campus Police.
Filing a police report with a CCPD officer will not obligate th
e victim to prosecute, nor will it subject the
victim to scrutiny or judgmental opinions from officers. Filing a police report will:
Ensure that a victim of a sexual assault receives the necessary medical treatment and tests, at
no expense to the victim
Provide the opportunity for collection of evidence helpful in prosecution, which cannot be
obtained be obtained later (ideally a victim of sexual assault should not wash, douche, use
the toilet, or change clothing prior to a medical/legal exam)
Assure the victim has access to free confidential counseling from counselors specifically trained
in the area of sexual assault crisis intervention
When a sexual assault is reported to Campus Police, Campus Police may, with the victim’s consent,
notify other personnel as necessary to provide care and services to the victim. These personnel include
the President/Superintendent; Vice President of Student Services; Dean of Student
Services/Coordinator of Student Conduct and Grievance, Director of Diversity, Benefits and Compliance;
and/or the Associate Dean of Student Health and Wellness Services.
A student who alleges being a victim of a sexual assault may choose for the investigation to be
pursued through the criminal justice system and the Office of Student Conduct and Grievance, or only
Page 8 of 12
the latter. A representative from the Police Department or the Office of Student Conduct and
Grievance will guide the victim through the available options and support the victim in his or her
decision. Various counseling options are available from the College through Student Health and
Wellness Services and/or the Employee Assistance Program. Counseling and support services outside
the District system are available by contacting the National Sexual Assault Hotline at (800) 656-HOPE
(1-800-656-4673).
District disciplinary proceedings are detailed in the Cerritos College General Catalog. Both the victim
and accused are entitled to the same opportunities to have others present during a disciplinary
proceeding. Both the victim and accused will be informed of the outcome of any hearing. A student
found guilty of violation of the District sexual misconduct policy could be criminally prosecuted in the
state courts and may be suspended or expelled from the District for the first offense. Student
victims
have the option to change their academic situation after an alleged sexual assault, if such changes are
reasonably available.
SEX OFFENDER REGISTRATION
Sex offenders are required to register with the police in the jurisdiction in which they reside and at
institutions of higher learning if they are students or if they work as employees, contractors, or volunteers.
Sex offenders who may be required to register should do so at the Cerritos College Police Department,
located on the south side of campus at 11090 New Falcon Way, Cerritos CA 90703.
Information regarding registered sex offenders in the state of California can be obtained through the
Megan’s’ Law web site, located at
www.meganslaw.ca.gov. This information is also available, to the
public, at some local police departments and sheriff’s offices.
The Cerritos College Police Department does not provide public access to the Department of Justice
Megan’s Law program. There are several agencies in the local community where a member of the public
can access this information.
Public access to viewing the Megan’s Web program is generally by appointment, and it is recommended
that you call the agency before going to find out what hours the information is accessible.
CRIME STATISTICS
The following information is provided as part of Cerritos College’s continuing commitment to safety and
security on campus in compliance with the Jeanne Clery Disclosure of Campus Security Policy and
Campus Crime Statistics Act. Crime statistics from more than 600 U.S. colleges, universities and career
schools can be found at the website http://ope.ed.gov/security
.
Campus crime, arrest and referral statistics include those reported to the Campus Police Department,
local law enforcement agencies and District Staff with significant responsibility for the student and
campus activities.
Criminal Offenses - On Campus
2011
2012
2013
a.
Murder/Non-negligent
manslaughter
0
0
0
b.
Negligent manslaughter
0
0
0
c.
Sex offenses - Forcible
1
0
0
d.
Sex offenses - Non-forcible
Incest
0
0
0
Statutory Rape
0
0
0
Page 9 of 12
e. Robbery
1 0 0
f.
Aggravated assault
1
0
0
g.
Burglary
3
12
6
h. Motor vehicle theft 16 21 15
i.
Arson
0
0
0
j.
Domestic Violence
0
0
0
k. Dating Violence
0 0 0
l.
Stalking
0
0
1
Criminal Offenses - Public Property
2011
2012
2013
a.
Murder/Non-negligent
manslaughter
0
0
0
b.
Negligent manslaughter
0
0
0
c.
Sex offenses - Forcible
0
0
0
d.
Sex offenses - Non-forcible
Incest
0
0
0
Statutory Rape
0
0
0
e.
Robbery
1
0
0
f.
Aggravated assault
0
0
0
g.
Burglary
0
0
0
h.
Motor vehicle theft
0
0
0
i.
Arson
0
0
0
j.
Domestic Violence
0
0
0
k.
Dating Violence
0
0
0
l.
Stalking
0
0
0
Arrests - On Campus
2011
2012
2013
a.
Illegal weapons possession
2
3
1
b.
Drug law violations
4
2
2
c.
Liquor law violations
1
1
1
Disciplinary Actions/Judicial Referrals - On Campus
2011
2012
2013
a.
Illegal weapons possession
0
0
0
b.
Drug law violations
0
0
0
c.
Liquor law violations
0
0
0
Arrests - Public Property
2011
2012
2013
a.
Illegal weapons possession
0
0
0
b.
Drug law violations
0
1
0
c.
Liquor law violations
0
0
0
Disciplinary Actions/Judicial Referrals - Public Property
2011
2012
2013
a.
Illegal weapons possession
0
0
0
b.
Drug law violations
0
0
0
c.
Liquor law violations
0
0
0
Page 10 of 12
HATE CRIMES
Any crime will be reported in which the victim is intentionally selected because of his or her actual or
perceived race, religion, sexual orientation, gender identity, disability, ethnicity, or national origin.
Hate Crimes - On Campus (2011)
Category of Bias for Crimes Reported in 2011
Total Race Religion
Sexual
Orientation
Gender Disability
Ethnicity /
National
origin
a.
Murder/Non-negligent
manslaughter 0 0 0 0 0 0 0
b. Negligent manslaughter 0 0 0 0 0 0 0
c. Sex offenses - Forcible 0 0 0 0 0 0 0
d. Sex offenses - Non-forcible
Incest 0 0 0 0 0 0 0
Statutory Rape 0 0 0 0 0 0 0
e. Robbery
0 0 0 0 0 0 0
f. Aggravated assault 0 0 0 0 0 0 0
g. Burglary
0 0 0 0 0 0 0
h. Motor vehicle theft 0 0 0 0 0 0 0
i. Arson
0 0 0 0 0 0 0
j. Simple Assault 0 0 0 0 0 0 0
k. Larceny-theft 0 0 0 0 0 0 0
l. Intimidation 0 0 0 0 0 0 0
m.
Destruction/damage/vandalism of
property
0 0 0 0 0 0 0
Hate Crimes - On Campus (2012)
Category of Bias for Crimes Reported in 2012
Total Race Religion
Sexual
Orientation
Gender Disability
Ethnicity /
National
origin
a.
Murder/Non-negligent
manslaughter 0 0 0 0 0 0 0
b. Negligent manslaughter 0 0 0 0 0 0 0
c. Sex offenses - Forcible 0 0 0 0 0 0 0
d. Sex offenses - Non-forcible
Incest 0 0 0 0 0 0 0
Statutory Rape 0 0 0 0 0 0 0
e. Robbery
0 0 0 0 0 0 0
f. Aggravated assault 0 0 0 0 0 0 0
g. Burglary
0 0 0 0 0 0 0
h. Motor vehicle theft 0 0 0 0 0 0 0
i. Arson
0 0 0 0 0 0 0
j. Simple Assault 0 0 0 0 0 0 0
k. Larceny-theft 0 0 0 0 0 0 0
l. Intimidation 0 0 0 0 0 0 0
m.
Destruction/damage/vandalism of
property
1 1 0 0 0 0 0
Page 11 of 12
Hate Crimes - On Campus (2013)
Category of Bias for Crimes Reported in 2013
Total Race Religion
Sexual
Orientation
Gender Disability
Ethnicity /
National
origin
a.
Murder/Non-negligent
manslaughter 0 0 0 0 0 0 0
b. Negligent manslaughter 0 0 0 0 0 0 0
c. Sex offenses - Forcible 0 0 0 0 0 0 0
d. Sex offenses - Non-forcible
Incest 0 0 0 0 0 0 0
Statutory Rape 0 0 0 0 0 0 0
e. Robbery
0 0 0 0 0 0 0
f. Aggravated assault 0 0 0 0 0 0 0
g. Burglary
0 0 0 0 0 0 0
h. Motor vehicle theft 0 0 0 0 0 0 0
i. Arson
0 0 0 0 0 0 0
j. Simple Assault 0 0 0 0 0 0 0
k. Larceny-theft 0 0 0 0 0 0 0
l. Intimidation 0 0 0 0 0 0 0
m.
Destruction/damage/vandalism of
property
0 0 0 0 0 0 0
Hate Crimes - Public Property (2011)
Category of Bias for Crimes Reported in 2011
Total Race Religion
Sexual
Orientation
Gender Disability
Ethnicity /
National
origin
a.
Murder/Non-negligent
manslaughter
0
0
0
0
0
0
0
b.
Negligent manslaughter
0
0
0
0
0
0
0
c.
Sex offenses - Forcible
0
0
0
0
0
0
0
d.
Sex offenses - Non-forcible
Incest
0
0
0
0
0
0
0
Statutory Rape
0
0
0
0
0
0
0
e.
Robbery
0
0
0
0
0
0
0
f.
Aggravated assault
0
0
0
0
0
0
0
g.
Burglary
0
0
0
0
0
0
0
h.
Motor vehicle theft
0
0
0
0
0
0
0
i.
Arson
0
0
0
0
0
0
0
j.
Simple Assault
0
0
0
0
0
0
0
k.
Larceny-theft
0
0
0
0
0
0
0
l.
Intimidation
0
0
0
0
0
0
0
m.
Destruction/damage/vandalism of
property
0 0 0 0 0 0 0
Page 12 of 12
Hate Crimes - Public Property (2012)
Category of Bias for Crimes Reported in 2012
Total Race Religion
Sexual
Orientation
Gender Disability
Ethnicity /
National
origin
a.
Murder/Non-negligent
manslaughter
0
0
0
0
0
0
0
b.
Negligent manslaughter
0
0
0
0
0
0
0
c.
Sex offenses - Forcible
0
0
0
0
0
0
0
d.
Sex offenses - Non-forcible
Incest
0
0
0
0
0
0
0
Statutory Rape
0
0
0
0
0
0
0
e.
Robbery
0
0
0
0
0
0
0
f.
Aggravated assault
0
0
0
0
0
0
0
g.
Burglary
0
0
0
0
0
0
0
h.
Motor vehicle theft
0
0
0
0
0
0
0
i.
Arson
0
0
0
0
0
0
0
j.
Simple Assault
0
0
0
0
0
0
0
k.
Larceny-theft
0
0
0
0
0
0
0
l.
Intimidation
0
0
0
0
0
0
0
m.
Destruction/damage/vandalism of
property
0 0 0 0 0 0 0
Hate Crimes - Public Property (2013)
Category of Bias for Crimes Reported in 2013
Total Race Religion
Sexual
Orientation
Gender Disability
Ethnicity /
National
origin
a.
Murder/Non-negligent
manslaughter 0 0 0 0 0 0 0
b. Negligent manslaughter 0 0 0 0 0 0 0
c. Sex offenses - Forcible 0 0 0 0 0 0 0
d. Sex offenses - Non-forcible
Incest 0 0 0 0 0 0 0
Statutory Rape 0 0 0 0 0 0 0
e. Robbery
0 0 0 0 0 0 0
f. Aggravated assault 0 0 0 0 0 0 0
g. Burglary
0 0 0 0 0 0 0
h. Motor vehicle theft 0 0 0 0 0 0 0
i. Arson
0 0 0 0 0 0 0
j. Simple Assault 0 0 0 0 0 0 0
k. Larceny-theft 0 0 0 0 0 0 0
l. Intimidation 0 0 0 0 0 0 0
m.
Destruction/damage/vandalism of
property
0 0 0 0 0 0 0
AD Administration
AP Automotive Partners
AQ Aquatics Center
AT Automotive Technology
BC Burnight Center/Theatre
BE Business Education
BK Bookstore
CA Culinary Arts (Temporary)
CB Classroom Building
CDC Child Development Center
CE Community Education
CP Campus Police
CS Career Services
EO/TT EOPS / Teacher Trac
FA Fine Arts
FC Facilities
FD Food Court
FH Field House
GYM Gymnasium
HS Health Science
ID Student ID Center
IS International Students Center
ISC Instructional Support Center
LA Liberal Arts
LB Library
LC Learning Resource Center
MC Modular Classrooms
ME Metals
MP Multi Purpose
NU Northwood University
PA Public Affairs/Cerritos College Foundation
PE Physical Education
PST Physical Science and Technology
PW Purchasing/Warehouse
RD Research and Development
S Science/Project Hope
SA Student Activities
SB Santa Barbara
SC Student Center
SH Student Health & Wellness
SL Skills Lab
SS Social Science
SSC Student Services Center (One Stop)
SSO Student Success Office
ST Falcon Stadium
TE Technology
WD Wood Manufacturing Technology
WT Weight Training
CERRITOS COLLEGE
ST
BK
BC
LB
SSO
AT
SS
MP
CS
AD
SSC
ME
WT
SH
TE
CE
FA
SB
CP
FH
LC
PE
BE
SC
NEW FALCON WAY
STUDEBAKER RD
C-4
C-3
C-2
C-1
C-5
C-6
GRIDLEY
ROAD
C-10
C-12
C-11
C-7
C-8
(Old) FALCON WAY
ID
F D
11110 Alondra Blvd, Norwalk, CA 90650 (562) 860-2451
VINTAGE
CERRITOS
AT
AQ
AQ
AQ
CDC
Kincaid Field
Soccer
Field
9 Jun 2014 TWK
PA
CB
SL
Tennis
Cou rts
FC
N
S
COW
HS
SA
E O / T T
AP
NU
Alondra
Drop Off
PST
ALONDRA BLVD
166th ST
WD
PW
Nancy Kelly
Softball
Field
IS
RD
MC
LA
GYM
CDC under
Construction
until Dec 14
Under
Construction
until Fall 2016
Construction until 8/15
CA
Employee Feedback
The Human Resources Department strives for high quality service at all times. We ask that you
complete this survey to help assess our services. Your input is valuable as you have become
part of the Cerritos family and your honest assessment of our services in the Human Resources
Department will help us better serve our employees.
This survey is confidential (no name required) and it will not affect you in anyway during your
employment with the District. We encourage your comments on all aspects of any service.
RECRUITMENT AND SELECTION
Statement
Strongly
Agree
Agree
Disagree
Strongly
Disagree
No
Comment
Staff was courteous and helpful
Staff provided complete and accurate
information to you
A timely response was provided
Instructions and documents provided by
the HR Department were clear
My overall experience was positive
Comments:
HUMAN RESOURCES PROCESSING
Statement
Strongly
Agree
Agree
Disagree
Strongly
Disagree
No
Comment
Staff was courteous and helpful
Classification:
Faculty Classified Confidential Management
Academic Year Hired:
Full-time Part-time
Cerritos College
Office of Human Resources
(562) 860-2451, Extension 2284
www.cerritos.edu/hr
CONTINUE ON BACK…
Staff provided complete and accurate
information to you
A timely response was provided
Instructions and documents provided by
the HR Department were clear
My overall experience was positive
Comments:
BENEFITS
Statement
Strongly
Agree
Agree
Disagree
Strongly
Disagree
No
Comment
Staff was courteous and helpful
Staff provided complete and accurate
information to you
A timely response was provided
Instructions and documents provided by
the HR Department were clear
My overall experience was positive
Comments:
Thank you for taking the time to complete this assessment.
Please return this form by inter-office or U.S. mail to:
Dr. Adriana Flores-Church
Director, Human Resources/Risk Management
Cerritos College
11110 Alondra Blvd.
Norwalk, CA 90650
(Please mark CONFIDENTIAL on the envelope)
Cerritos College
Rideshare Bulletin
My name is Dominic Sarabia and I am the Employee Transportation Coordinator for
Cerritos College. If you would like information on carpooling please feel free to contact
my office at extension #2326 or via email at dsarabia@cerritos.edu .
To assist your commute, I have provided several links below for your information on
carpooling, traffic information, daily air quality, etc.
Metro’s Commute Services go to their web site at:
www.metro.net/riding_metro/commute_services/share.htm
For real time traffic information:
www.commutesmart.info/trafficupdates/index.html
For local air quality and conditions:
http://airnow.gov/index.cfm?action=airnow.showlocal&CityID=130
Caltrans Live Traffic Camera and Traffic Information:
http://video.dot.ca.gov/
Caltrans Traveler Services:
http://www.dot.ca.gov/roadsandtraffic.html
California Highway Patrol Traffic Incident Information Page:
http://cad.chp.ca.gov/
Links to other Local Transit Agencies and Bus Line #’s
Line #1 http://www.ci.cerritos.ca.us/where/COW_new.html
Norwalk Transit Line # 2 & 3 http://www.ci.norwalk.ca.us/transportation.asp
Line # 172 & 173 http://www.lbtransit.com/
http://www.octa.net/
Line #128 http://www.metro.net/riding_metro/default.htm
Buckle Up! Remember to wear your seatbelt while driving.
www.aqmd.gov
CERRITOS COLLEGE POLICE DEPARTMENT
Memorandum
TO: New or Re-Active Rideshare Participant
FROM: Dominic Sarabia, Parking Coordinator/Campus Police Department
DATE: November 21, 2013
RE: Rideshare Sign-up Application
Welcome to Cerritos College! My name is Dominic Sarabia and I am the Employee
Transportation Coordinator for Cerritos College. The Employee Commute Rideshare
Program is offered to all employees of Cerritos College with the benefit of earning up to
six (6) hours of vacation time per quarter or up to $45.00 cash per quarter. Only full-time
employees have the option of receiving either vacation hours or pay, all part-time
employees are offered only the cash benefit.
Attached is the alternative transportation program application. Please fill out the first two
pages and return to my office at the Campus Police Department. Once your application is
received and processed, you will receive a “Certified Carpooler” parking permit that will
be used in conjunction with your staff parking permit to park in the designated Carpool
Parking spaces which are located throughout the campus. If you have any carpool
partner(s), they also need to request an application and return it to my office.
Please make your own copies of the Monthly Alternative Transportation Verification
Form; this form will be turned in at the end of each month.
Please make sure that you
read the instructions for completing the form and that the form is completely filled out
and signed by you and your immediate supervisor.
Thank you for joining the effort to clean up our air. If you have any questions, please feel
free to contact me, Dominic Sarabia, at extension #2326.
Attachments
CERRITOS COLLEGE EMPLOYEE RIDESHARING AGREEMENT
The below listed employees hereby agree to the following provisions of the Cerritos
College Ridesharing Agreement:
1. Each member will purchase a parking permit.
2. Each member will display their individual staff parking permit so they are clearly
visible.
3. Each member bringing a student to any school campus, a child to a child daycare
center, or a babysitter must request a carpool pass to display with their parking
permit from the ETC.
Cerritos College agrees to assist the below listed employees by providing the following:
1. A designated parking space for the rideshare vehicle in
lot______________________ (please choose).
2. A guaranteed ride home for any member of the rideshare group who needs to
leave due to illness of family emergency.
Print Name Employee # & SS # Parking Permit #
____________________________ _______________________ _________________
____________________________ _______________________ _________________
____________________________ _______________________ _________________
____________________________ _______________________ _________________
The undersigned agrees to abide by the terms of this agreement and to notify the college
Employee Transportation Coordinator if there any changes or additions to this rideshare
group. Each member of the rideshare group must sign and date below. Each member of
the rideshare group must submit a separate enrollment form and ridesharing agreement.
Signature Date
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
CERRITOS COLLEGE EMPLOYEE RIDESHARING AGREEMENT
I, _____________________________, have been working the hours of ______________
to _______________ (do not use military time). My employee # is _________________
and my Social Security # is ____________________________. I hereby agree to enroll
in the Cerritos College Alternative Transportation Program by participating in one or
more of the following activities.
1. Walking to work.
2. Riding a bicycle to work.
3. Riding a bus to work.
4. Participating in a rideshare group.
5. Other alternative to driving along (i.e. childcare, 9/80 work schedule, dropped off
by another employee from a different employer, riding with a student, dropped off
a child or student at a school, ride to work with another employee, etc.).
Cerritos College agrees to pay me one dollar twenty-five cents ($1.25)* or ten (10)
minutes of vacation time (classified and management employees only) for each point that
I earn by participating in one or more of the above activities. Incentives will be paid at
the end of each three (3) month quarter. Vacation time will be rounded up if over one-
half (1/2) of a fifteen (15) minute increment or rounded down if less than one-half (1/2)
of a fifteen (15) minute increment. A MAXIMUM OF THIRTY-SIX (36) POINTS
WILL BE PAID PER QUARTER.
I elect:
To be paid a taxable monetary incentive which will be included in my regular payroll
warrant at the end of each quarter (available to all employees).
To earn a vacation incentive which will be kept on file in the payroll department
(classified and management only).
Participant: ______________________________ ____________ ____________
Signature Ext. Date
Received by: _____________________________ ____________ ____________
ETC Ext Date
ATP-1 Rev. (01/04)
Alternative Transportation Verification Form
Name: _____________________________ SS#: ________________________________
Print: Last, First
Work Location: ______________________ Emp. #: _____________________________
Verification For: _____________________ ______________________________
Month Year
INSTRUCTIONS FOR COMPLETING THIS FORM:
1. Please circle the commute code and the number for each day which you participated,
leave weekends or days driven alone blank.
2. Obtain immediate manager’s signature as verification.
3. Sign and date this form.
4. Submit this form to the Employee Transportation Coordinator - Dominic Sarabia no later
than 3 working days after the end of each month to the Campus Police.
5. This form must be filled out completely to receive credit.
Commute Code
:
Carpool Bus Bike CNG Walk Child Care 9/80 Dropped Off Telecommute
(Circle)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Total Days: _________
Alternative Transportation Incentives: VACATION / CASH to be credited quarterly
(Circle One)
I certify attendance as shown above:
________________________________________ _____________ ____________
Signature of Immediate Manager Extension Date
I certify that I have participated in the Alternative Transportation Program as indicated above and in
accordance with the provisions of the enrollment agreement signed by me. Any falsification will
immediately terminate my enrollment in the program.
________________________________________ _____________ ____________
Signature of Participant Extension Date
ATP-12/2005
Cerritos College
Human Resources
MEMO TO: New Employees
FROM: Human Resources Office
SUBJECT: TUBERCULOSIS EXAMINATION REQUIREMENT
In order for you to receive clearance for employment at Cerritos College, the District policy
requires that you obtain and submit to the Human Resources Office, the results of a tuberculosis
screening examination, which verifies that you are free of active tuberculosis.
To fulfill this requirement, you may use your personal physician or a public health facility. For
your convenience, on the reverse side of this memorandum there is a listing of public health
facilities where tuberculin tests can be obtained.
TUBERCULOSIS REFERRAL
1. Hawaiian Garden Health Center
22310 Wardham Ave.
Hawaiian Gardens, CA. 90716
(562) 420-2433
WALK-IN ONLY
Monday Friday (Before 11am)
TB skin test cost: $25.00
Chest X-Ray: NOT AVAILABLE
2. Long Beach Health Department
2525 Grand Ave., Room # 104
Long Beach, CA. 90815
(562) 570-4221
BY APPOINTMENT ONLY
Monday Wednesday, & Friday only (8am 11am, 1pm 4pm)
TB skin test cost: $22.60
Chest X-Ray: $56 (Monday, Wednesday, & Friday by appointment)
3. Whittier Health Department
7643 S. Painter
Whittier, CA. 90602
(between Mar Vista & Walnut)
(562) 464-5350
WALK-IN ONLY
TB skin test cost: Free of Charge!
Monday, Tuesday, and Friday only (7:30am 10am)
First come, first serve for the 1
st
10 people ONLY!
Chest X-Ray: Free of Charge!
Web Resources:
www.cdc.gov/chstp/tb/faqus/qa.htm
www.dhhs.gov
www.healthfinder.gov
www.labtestsonline.org
www.lapublichealth.or/tb/faq/skinqa.htm
www.nationaltbcenter.edu
www.nih.gov
Grade Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8
45 11,977 12,371 12,780 13,201 13,637 14,088 14,552 15,033
44 11,594 11,977 12,371 12,780 13,201 13,637 14,088 14,552
43 11,224 11,594 11,977 12,371 12,780 13,201 13,637 14,088
42 10,866 11,224 11,594 11,977 12,371 12,780 13,201 13,637
41 10,518 10,866 11,224 11,594 11,977 12,371 12,780 13,201
40 10,182 10,518 10,866 11,224 11,594 11,977 12,371 12,780
39 9,854 10,182 10,518 10,866 11,224 11,594 11,977 12,371
38 9,536 9,854 10,182 10,518 10,866 11,224 11,594 11,977
37 9,229 9,536 9,854 10,182 10,518 10,866 11,224 11,594
36 8,931 9,229 9,536 9,854 10,182 10,518 10,866 11,224
35 8,644 8,931 9,229 9,536 9,854 10,182 10,518 10,866
34 8,364 8,644
8,931
9,229 9,536 9,854 10,182 10,518
33 8,096 8,364 8,644 8,931 9,229 9,536 9,854 10,182
32 7,834 8,096 8,364 8,644 8,931 9,229 9,536 9,854
31 7,582 7,834 8,096 8,364 8,644 8,931 9,229 9,536
30 7,338 7,582 7,834 8,096 8,364 8,644 8,931 9,229
29 7,102 7,338 7,582 7,834 8,096 8,364 8,644 8,931
28 6,872 7,102 7,338 7,582 7,834 8,096 8,364 8,644
27 6,651 6,872 7,102 7,338 7,582 7,834 8,096 8,364
26 6,437 6,651 6,872 7,102 7,338 7,582 7,834 8,096
25 6,230 6,437 6,651 6,872 7,102 7,338 7,582 7,834
24 6,029 6,230 6,437 6,651 6,872 7,102 7,338 7,582
23 5,834 6,029 6,230 6,437
6,651
6,872 7,102 7,338
22 5,649 5,834 6,029 6,230 6,437 6,651 6,872 7,102
** Approved by the Board of Trustees: April 16, 2014
MGMT_0.85
manager’s immediate supervisor and subject to approval by the President/Superintendent. (AP 7250)
* Advancement from one step to the next on the appropriate salary schedule shall be dependent upon the recommendation of the
Cerritos Community College District
Management Employees Salary Schedule*
Effective Date: 7/1/2014**
Cerritos Community College District Procedure No. 3050
General Institution
AP 3050 INSTITUTIONAL CODE OF ETHICS
1
Reference: 2
Accreditation Standard III.A.1.d 3
Definition of Ethics 4
Ethical behavior is often defined as “right” or “good” behavior as measured against 5
commonly accepted rules of conduct for a society or for a profession. The ethical 6
person is often described in absolute terms as one who is fair, honest, straightforward, 7
trustworthy, dispassionate, and unprejudiced. If, however, one is inconsistently fair or 8
honest, one loses credibility and is perceived to be unethical. The ethical person must 9
be conspicuously consistent in the exercise of integrity to sustain the credibility that is 10
an expectation of office. 11
Importance of Ethics 12
The credibility of the District’s employees depends upon whether they are perceived as 13
honest men and women. If integrity contributes to credibility, then ethical behavior is a 14
singular prerequisite to successful performance. 15
Statements of ethical standards do not necessarily ensure ethical behavior. Yet public 16
statements of intent surely create an expectation that employees will indeed act with 17
integrity in the public interest. 18
Expectations for Ethical Behavior 19
Employees of the District shall be committed to the principles of honesty and equity. 20
They shall not seek to abridge for any purpose the freedoms of other employees or 21
students. At the same time, they shall not willingly permit the interests of any members 22
of the college community to override the best interests of the public served by the 23
District. 24
Employees shall exercise judgments that are dispassionate, fair, consistent, and 25
equitable. They shall exhibit openness and reliability in what they say and do as 26
educational leaders. They shall confront issues and people without prejudice. They 27
shall demonstrate a commitment to excellence in education and uncompromising 28
commitment to the principles of ethical behavior. 29
Similarly, students are expected to abide by ethical behavior and decision-making in 30
their treatment of District employees, other students, and members of the public. 31
Employee Responsibilities 32
As practitioners of ethical behavior, District personnel have a responsibility: 33
to provide and protect student access to the educational resources of the District;34
to protect human dignity and individual freedom, and assure that students are35
respected as individuals, as learners, and as independent decision-makers;36
to protect students from disparagement, ridicule, or capricious judgment;37
to keep foremost in mind at all times that the District exists to serve students;38
to foster a climate of trust and mutual support;39
to foster openness by encouraging and maintaining two-way communication;40
to encourage, support, and abide by the written Board Policies and41
Administrative Procedures of the District; and42
to challenge unethical behavior in a timely manner.43
Office of Primary Responsibility: Office of the President/Superintendent 44
Date Approved: November 26, 2007
AUGUST 2010
Ca
lifornia law guarantees certain benefits to
employees who are injured or become ill
because of their jobs.
Any job related injury or illness is covered.
Types of injuries include, but may not be
limited to, strains, sprains, cuts, cumulative
or repetitive traumas, fractures, illnesses and
aggravations. Some injuries from voluntary,
off duty, recreational, social or athletic
activity may not be covered. Check with
your supervisor or Keenan HealthCare if
you have any questions.
All work related injuries must be reported
to your supervisor immediately. Don’t
delay. There are time limits. If you wait too
long, you may lose your right to benefits.
Your employer is required to provide you a
claim form within one working day after
learning about your injury.
It is a misdemeanor for an employer to
discriminate against workers who are
injured on the job or who testify in another
employee’s case. Any such employee may
be entitled to compensation, reinstatement
and reimbursement for lost wages and
benefits.
Med
ical Care – All medical treatment,
without a deductible or dollar limit. For
dates of injury on or after 1/1/04 there is a
limit of 24 chiropractic, 24 physical therapy
and 24 occupational therapy visits. However
this limit does not apply for post surgical
treatment. Costs are paid directly by Keenan
HealthCare, through your employers
workers’ compensation program, so you
should never see a bill.
If emergency treatment is required go to the
nearest emergency room or contact 911.
Keenan HealthCare will arrange medical
treatment, often by a specialist for the
particular injury. Preferred Provider
Networks may be utilized for physicians as
well as medical care centers.
If your employer offers group health
insurance you are eligible to treatment with
your personal physician should you become
injured on the job. If you are eligible,
before you are injured
, you must notify
your employer in writing and provide your
employer written documentation from your
personal physician that they agree to be
predesignated. Your personal physician
must be your regular primary care physician
who previously directed your medical
treatment, who retains your medical history
and records. You may only predesignate
your primary care physician if they are a
family practitioner, general practitioner,
board certified or board eligible internist,
obstetrician-gynecologist, pediatrician or a
multi-specialty medical group, whose
practice is predominantly for non-
occupational injuries and illnesses.
Your employer may be using a Medical
Provider Network (MPN), which is a
selected group of health care providers to
provide treatment to workers injured on the
job. If you have predesignated a personal
physician prior to your work injury, then
you may receive treatment from your
predesignated doctor. If you have not
predesignated and your employer is using
and MPN, you are free to choose an
appropriate provider from the MPN list
after the first medical visit directed by your
employer or Keenan & Associates. For
more information, see the MPN contact
information on reverse side.
If your employer does not
participate in a
Medical Provider Network (MPN) you may
be able to change your treating physician to
your personal chiropractor or acupuncturist.
Generally your employer, or Keenan, has
the right to select your treating physician
within the first 30 days after your employer
knows of your injury or illness. After your
employer, or Keenan, initiates treatment
you may, upon request, have your treatment
transferred to your personal chiropractor or
acupuncturist. To be eligible you must
notify your employer in writing prior to
being injured.
If a work injury occurs
pamphlet
Workers’ compensation benefits include
AUGUST 2010
Your employer will provide you with a form
to use an optional method to predesignate
your personal physician
.
C
ont
act Keenan HealthCare if you plan to
change physicians at any time.
Payment for Lost Wages - If you’re
temporarily disabled by a job injury or
illness, you’ll receive tax-free income until
your doctor says you are able to return to
work. Payments are two-thirds of your
average weekly pay, up to a maximum set by
state law. Payments aren’t made for the first
three days unless you are hospitalized in an
inpatient basis or unable to work more than
14 days.
If the injury or illness results in permanent
disability, additional payments will be made
after recovery. If the injury results in death,
benefits will be paid to surviving
dependents.
You may be entitled to a
Supplemental
Job Displacement Voucher
, which
entitles you to a voucher for educational
training.
Contact your employer representative or
Keenan HealthCare if you have questions
about workers’ compensation benefits. You
may also contact and Information and
Assistance Officer at the State Division of
Workers’ Compensation. You can consult
an attorney. Most attorneys offer one free
consultation. If you decide to hire an
attorney, his or her fee will be taken out of
some of your benefits. For names of
workers’ compensation attorneys, call the
State Bar of California at 415-538-2120.
You can get free information from a state
Division of Workers’ Compensation
Information & Assistance Officer. The
phone numbers are listed below. Hear
recorded information by calling toll-free
800-736-7401 or visit www.dwc.ca.gov.
Anaheim 714-414-1801
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800-654-8102
How to obtain additional information
Department of Workers’ Compensation
Information and Assistance Offices
Keenan H
ealthCare adjusting locations
Cerritos Community College District Procedure No. 3518
General Institution
AP 3518 CHILD ABUSE AND NEGLECT REPORTING
1
References: 2
Penal Code, Sections 261, 264.1, 273a, 273d, 285, 286, 288, 288a, 289, 647a, 3
and 11164-11174.3 (“Child Abuse and Neglect Reporting Act); 4
Welfare and Institutions Code, Sections 300, 305, 318, and 601; 5
Family Code, Sections 7802, 7807, 7808, 7820-7829, 7890, and 7892 6
The District recognizes the responsibility of its staff to report to the appropriate agency 7
when there is a reasonable suspicion that an abuse or neglect of a child (under the age 8
of 18 years) may have occurred. 9
“Reasonable suspicion” occurs when “it is objectively reasonable for a person to 10
entertain such a suspicion, based upon facts that could cause a reasonable person in a 11
like position, drawing, when appropriate, on his or her training and experience, to 12
suspect child abuse or neglect.” (Penal Code, Section 11166(a)(1)) 13
Definition of Child Abuse or Neglect 14
“Child abuse” is defined as physical abuse, sexual abuse, and/or serious emotional 15
maltreatment, as well as sexual assault, sexual exploitation, and/or the willful cruelty or 16
unjustifiable punishment of a child; incidents of unlawful corporal punishment or injury 17
against a child; or abuse in out-of-home care. (Penal Code, Section 11165) 18
“Neglect” means the negligent treatment or maltreatment of a child by a person 19
responsible for the child’s welfare under circumstances indicating harm or threatened 20
harm to the child’s health or welfare. It includes the negligent failure of a person having 21
the care or custody of a child to provide adequate food, clothing, shelter, medical care, 22
or supervision such that the child’s health is endangered. (Penal Code, Section 23
11165.2) 24
Mandated Reporters 25
Mandated reporters include faculty members, educational administrators, and classified 26
staff. Volunteers are not mandated reporters but are encouraged to report suspected 27
abuse or neglect of a child. (Penal Code, Section 11165 (b)) 28
Reports of Child Abuse or Neglect 29
If a mandated reporter suspects child abuse or neglect, he or she must first make a 30
verbal report to the Department of Children & Family Services Child Protection Hotline 31
at 1-800-540-4000. 32
Mandated reporters must report immediately any reasonable suspicion of child abuse to 33
a local child protective agency such as the Hotline and follow up with a written report 34
within 36 hours. (Penal Code, Section 11166(a)) 35
After a verbal report of abuse or neglect is made, the Hotline will provide mandated 36
reporters with a 19-digit referral number which will be needed to complete the 37
mandatory written report. This report of child abuse and/or neglect must be made on 38
Form SS 8572; copies of this form are available in the Human Resources Office, 39
through the Child Development Center and on the web at 40
https://mandreptla.org/onlineRep.htm. 41
Once the written report of child abuse or neglect is completed, it should be mailed to the 42
following address: 43
Child Protection Hotline 44
3075 Wilshire Boulevard, Fifth Floor 45
Los Angeles, CA 90010 46
Immunity and Failure to Report when Required 47
No mandated reporter who reports a known or suspected instance of child abuse shall 48
be civilly or criminally liable for any report required or authorized by the Penal Code. 49
Any person other than a child care custodian reporting a known or suspected instance 50
of child abuse shall not incur any liability as a result of making any report of child abuse, 51
unless it can be proven that a false report was made and the person knew that the 52
report was false (Penal Code, Section 11172(a)). 53
Any person not mandated by law to report suspected child abuse has immunity unless 54
the report is proven to be false and the person reporting knows it is false, or the report is 55
made with reckless disregard of the truth or falsity of the incident (Penal Code, Section 56
56
11172(a)). 57
Reporting is an individual responsibility. An employee making a report cannot be 58
required to disclose his or her identity to the employer. (Penal Code, Section 59
11166(h)(2)) However, a person who fails to make a required report is guilty of a 60
misdemeanor punishable by up to six months in jail and/or up to a $1,000 fine (Penal 61
Code, Section 11166.5(b)). 62
Obligation and Compliance Information Provided to Mandated Reporters
63
The District shall provide each mandated reporter with a statement informing him or her 64
of the fact that he or she is a mandated reporter and of his or her reporting obligations 65
and confidentiality rights under Penal Code, Section 11166.5(a) and of his or her 66
confidentiality rights under subdivision Penal Code, Sections 11166.5(a) and 67
11167(d)(1). 68
The District shall provide a copy of Penal Code, Sections 11165.7 (Mandated Reporter),
69
11166 (Report: Duty, Time & Method), and 11167 (Report: Confidentiality of persons 70
reporting) to each mandated reporter, along with the statement. Prior to commencing 71
his or her employment and as a prerequisite to that employment, the employee shall 72
sign and return the statement to the District. The signed statements shall be retained 73
by the District (Penal Code, Section 11166.5). 74
The District shall distribute this procedure to all mandated reporters.
75
Offices of Primary Responsibility: Vice President, Student Services 76
Human Resources 77
Date Approved: November 26, 2007
Date Revised: June 18, 2008
Cerritos Community College District
Request for Transfer of Sick Leave
1. STATEMENT OF TRANSFERRING EMPLOYEE:
This is to certify that I,
(Name) (Social Security #)
was employed by
District.
Address:
I was employed in a
certificated
non-certificated capacity:
From: To:
Signature of Employee: Date
2. REQUEST BY EMPLOYING DISTRICT
The above named person has been employed by this District. This is to request that the
amount of unused sick leave due the above named employee be transferred to this District.
(Ed Code §87782, 87783, 87785, and 88202)
Human Resources Office
Cerritos Community College District
11110 Alondra Blvd Norwalk, CA 90650
(562) 860-2451, Extension 2284
Fax Number: (562) 467-5003
______________________________________________________ ________________________________________
Dr. Adriana Flores-Church Date
Director of Human Resources/Risk Management
3. RESPONSE BY FORMER DISTRICT
This is to certify that the above named person was employed by this District
from to and that the following
information is true and correct.
Total Earned Sick Leave days
OR
hours
Minus Used Sick Leave days
OR
hours
Total Sick Leave Being Transferred days
OR
hours
Signature Date
Print Name Title
(Upon completion, please return this form to the requesting District’s address or via FAX as shown in item #2 above)
Revised 10/08
(800) 531-0200
C
BENEFICIARY DESIGNATION
PERS-BSD-241 (Revised 12/04)
TO: CalPERS/ Benefit Services Division
P.O. Box 942711
Sacramento, CA 94229-2711
Fax:(916) 795-3933
Phone:(888) CalPERS (225-7377)
MEMBER’S FULL NAME (PLEASE PRINT) SOCIAL SECURITY NUMBER BIRTH DATE
TELEPHONE NUMBER
I understand that if I am married or in a registered domestic partnership but do not name my spouse or domestic partner as beneficiary, she/he
may still be entitled to a community property share of my ‘Lump Sum Contributions’ or a share of any monthly allowance that may be payable. My
‘Non-Spouse or Non-Partner’ designated beneficiaries will receive the portion of my lump sum benefits, which are not payable to my spouse or
domestic partner as his/her community property share. I further understand that if my death is determined to be “Industrial,” special death
benefits will be paid in the manner prescribed by law. If no percentage (%) is given, the applicable benefits will be paid SHARE AND SHARE
ALIKE.
PRIMARY BENEFICIARIES
FIRST NAME MIDDLE NAME LAST NAME
% RELATIONSHIP TO MEMBER SOCIAL SECURITY NUMBER
ADDRESS (Number and Street) (City) (State) (Zip Code)
FIRST NAME MIDDLE NAME LAST NAME
% RELATIONSHIP TO MEMBER SOCIAL SECURITY NUMBER
ADDRESS (Number and Street) (City) (State) (Zip Code)
FIRST NAME MIDDLE NAME LAST NAME
% RELATIONSHIP TO MEMBER SOCIAL SECURITY NUMBER
ADDRESS (Number and Street) (City) (State) (Zip Code)
In the event that I survive the person(s) named above, I hereby designate the following person(s) who survive me, as BENEFICIARIES. If
no percentage (%) is given, benefits will be paid SHARE AND SHARE ALIKE.
SECONDARY BENEFICIARIES
FIRST NAME MIDDLE NAME LAST NAME
% RELATIONSHIP TO MEMBER SOCIAL SECURITY NUMBER
ADDRESS (Number and Street) (City) (State) (Zip Code)
FIRST NAME MIDDLE NAME LAST NAME
% RELATIONSHIP TO MEMBER SOCIAL SECURITY NUMBER
ADDRESS (Number and Street) (City) (State) (Zip Code)
Should I survive all of the persons named above, I understand that the benefits payable on account of my death will be paid to my
statutory beneficiaries, or to such other beneficiary or beneficiaries that I may hereafter designate in writing to the Board of
Administration, all in accordance with the applicable provisions of law.
BY THIS BENEFICIARY DESIGNATION, I HEREBY REVOKE ANY PREVIOUS DESIGNATION I HAVE FILED. I UNDERSTAND THAT MY MARRIAGE
OR REGISTERED DOMESTIC PARTNERSHIP, DISSOLUTION OR ANNULMENT OF MY MARRIAGE OR DOMESTIC PARTNERSHIP, OR THE BIRTH
OR ADOPTION OF A CHILD OR TERMINATION OF MEMBERSHIP SUBSEQUENT TO THE DATE I FILE THIS FORM WITH CALPERS, WILL
AUTOMATICALLY VOID THIS DESIGNATION. HOWEVER, A DESIGNATION FILED
AFTER
THE INITIATION OF A DISSOLUTION/ANNULMENT OF
MARRIAGE OR REGISTERED DOMESTIC PARTNERSHIP IS NOT REVOKED WHEN THE DISSOLUTION/ANNULMENT IS FINALIZED.
Signatures Required
Are you legally married or have a registered domestic partner? No Yes
If yes, your spouse or registered domestic partner must sign this form
If no, please indicate:
Never married/or Never in Domestic Partnership Divorced/Annulled Widowed
IMPORTANT – You must complete the BSD-800 on the reverse side of this form if you are married or have a registered
domestic partnership but your spouse or domestic partner is unable to sign below.
MEMBER SIGNATURE:
_________________________________________________________ Date: ________________
MEMBER ADDRESS: __________________________________________________________________________________________
(Number and Street) (City) (State) (Zip Code)
SPOUSAL/REGISTERED DOMESTIC PARTNER ACKNOWLEDGEMENT: By signing this beneficiary designation form, I
acknowledge the information entered by my spouse/domestic partner.
SPOUSE/DOMESTIC PARTNER SIGNATURE:
__________________________________________________________________
INFORMATION AND INSTRUCTIONS FOR CalPERS
BENEFICIARY DESIGNATION FORM
If you die before you retire, the Public Employees’ Retirement Law provides for payment of specific Death Benefits to your
surviving beneficiaries. Please see your personnel officer for a description of the benefits. The benefits are payable to the
following beneficiaries:
A. If you are a safety member and your death is job-related, or if you are not a safety member but you are fatally attacked
while performing your official job duties, the Special Death Benefit may be payable. This benefit is payable by law to your
surviving spouse/registered domestic partner (whether or not you were still living together at the time of your death) or, if
none, to your unmarried children/step-children under age 22, whether or not you have filed a beneficiary designation.
B. If you are eligible for retirement or you are a State member with at least 20 years of State service credit, a monthly death
benefit allowance may be payable. If you do not have a valid beneficiary designation on file, the benefits will be payable to
your surviving spouse/registered domestic partner to whom you have been married to or in a partnership with for either one
year or prior to the onset of the injury or illness that resulted in death. Or, if there is no eligible surviving spouse/registered
domestic partner, the allowance will be payable to your unmarried minor children, if any.
If you do have a valid beneficiary designation on file your spouse/registered domestic partner may still be entitled to a
community property share of your lump sum contributions or monthly death benefit allowance. However, your non-
spouse/non-domestic partner designated beneficiaries will receive the portion of your lump sum benefits which are not
payable to your spouse/registered domestic partner as his/her community property share.
C. If A and B do not apply and there is no valid Beneficiary Designation on file at the time of death, the benefits will be
payable to your survivors in the following order:
1. Your surviving spouse/registered domestic partner (whether or not you were still living together at the time of your
death); or, if none
2. Natural and adopted children, including (in limited situations) a natural child adopted by another, share and share alike;
or, if none,
3. Parents, share and share alike; or if none,
4. Brothers and sisters, share and share alike, or if none,
5. Your estate (if probated, or subject to probate), or if not,
6. Your trust (if one exists), or if not,
7. Stepchildren, share and share alike, or, if none,
8. Grandchildren, including step-grandchildren, share and share alike, or, if none,
9. Nieces and nephews, share and share alike, or, if none,
10. Great-grandchildren, share and share alike, or, if none,
11. Cousins, share and share alike.
If A and B do not apply and there is a valid Beneficiary Designation on file at the time of death, the benefits will be payable
to the beneficiary(ies) you designate on the form. However, if you are married or have a registered domestic partner
at the time of death, your spouse/domestic partner may still be entitled to a community property share of your
lump sum contributions.
D. You may designate or change your beneficiaries at any time by completing another Beneficiary Designation form. You
may name as beneficiary any person or persons, a corporation or your estate. Payment will be made to your estate only if
probated. You may designate a trust as your beneficiary; however, you must provide the name of the trust, the date of the
trust, and the name and address where the trust is filed. It is not necessary to provide the name of the trustee. Reminder:
If you are married or in a domestic partnership at the time of your death and you do not name your
spouse/domestic partner as beneficiary, he/she may still be entitled to a community property share of your lump
sum contributions or a share of any monthly allowance that may be payable.
E. Your Beneficiary Designation will be revoked automatically, and benefits will be payable to the closest survivor listed in
section C, if any of the following events occur after your designation form is received by CalPERS:
1. Marriage/Registration of Domestic Partnership; or
2. Dissolution or annulment of your marriage/domestic partnership. However, a designation filed after the initiation of a
dissolution/annulment of marriage or domestic partnership is NOT
revoked when the dissolution/annulment is finalized;
or
3. Birth or adoption of a child; or
4. Termination of membership that results in a refund of your contributions.
INSTRUCTIONS (See Reverse Side of This Page)
INSTRUCTIONS
1. Print clearly with ball point pen or type all information requested. If you make an error, make the necessary correction by
lining through the error and initialing the change.
No erasures or correction fluid will be accepted.
2. Enter on the form the full name of your beneficiaries, relationship, social security number (if known), and the complete
address for each. (If the form does not provide enough space, you may attach additional sheets provided you indicate
whether you are designating “primary” or “secondary” beneficiaries. You must sign, date, and write your social security
number at the top of each additional sheet.)
3. If a (%) is entered make sure the total equals 100%.
4. Your spouse/registered domestic partner must sign the form to acknowledge the names of the beneficiaries you are
designating. IMPORTANT: If you are unable to obtain your spouse’s/domestic partner’s signature, you MUST complete
the BSD-800, “Justification for Absence of Spouse or Domestic Partner’s Signature” form, on the reverse side of the
designation form or your designation form may be rejected.
5. Enter the date you signed the form and your current mailing address.
6. Mail the completed form to the Public Employees’ Retirement System at the address shown, or you may fax it to (916)
795-3933.
7. After CalPERS receives and reviews the form a confirmation letter will be mailed to you within 6 weeks. If the form is not
acceptable a new form will be mailed to you to complete.
IMPORTANT INFORMATION
The Information Practices Act of 1977 and the Federal Privacy Act require the California Public Employees’ Retirement System
to provide the following information to individuals who are asked to supply information. The information requested is collected
pursuant to the Government Code Sections (20000, et seq.) and will be used for administration of the Board’s duties under the
Retirement Law, the Social Security Act, and the Public Employees’ Medical and Hospital Care Act, as the case may be.
Failure to supply all of the requested information may result in the System being unable to perform its functions regarding your
status. Portions of this information may be transferred to: state and public agency employers, California State Attorney
General, Office of the State Controller, Teale Data Center, Franchise Tax Board, Internal Revenue Service, Workers’
Compensation Appeals Board, State Compensation Insurance Fund, County District Attorneys, Social Security Administration,
beneficiaries of deceased members, physicians, insurance carriers, and various vendors who prepare microfiche/microfilm for
CalPERS. Disclosure to these parties is done in strict accordance with current statutes regarding confidentiality.
You have the right to review your membership files maintained by the California Public Employees’ Retirement System. For
questions concerning your rights under the Information Practices Act of 1977, please contact the Information Practices Act
Coordinator, CalPERS, P.O. Box 942702, Sacramento, CA 94229
C
Benefit Services Division
P.O. Box 942711
Sacramento, CA 94229-2711
(888) Cal-PERS (225-7377)
TDD - (916) 795-3240; FAX (916) 795-3933
JUSTIFICATION FOR ABSENCE OF SPOUSE OR REGISTERED DOMESTIC PARTNER’S SIGNATURE
Pursuant to Government Code Section 21261, the member’s current spouse or registered domestic partner must
be made aware of the selection of benefits or change in beneficiary made by the member. The spouse or
domestic partner of a CalPERS member must acknowledge the submission of a request for refund of
contributions; election of retirement optional settlement; and designation of beneficiary for Pre-retirement Death
Benefits.
If a spouse or domestic partner’s signature does not appear on one of the above-mentioned documents, the following
information MUST be completed by the member and submitted with the application/form.
MEMBER’S NAME (TYPED OR PRINTED) SOCIAL SECURITY NUMBER
APPLICATION SUBMITTED
BENEFICIARY DESIGNATION (PERS-BSD-241)
Select either 1 or 2 and indicate specifics:
1. By checking this box, I indicate that I am not legally married or in a registered domestic partnership
because:
Never married or never in registered domestic partnership.
Divorced/marriage annulled or domestic partnership terminated. __________________
Date (mm/dd/yyyy)
Widowed. ________________________
Date (mm/dd/yyyy)
2. By checking this box, I indicate that I am married or have a domestic partner, but my spouse or
domestic partner did not sign this form because:
I do not know and have taken all reasonable steps to determine the whereabouts of my spouse or
domestic partner, OR,
My spouse or domestic partner has been advised of the application and has refused to sign the
written acknowledgement; OR
My spouse or domestic partner is incapable of executing the acknowledgement because of an
incapacitating mental or physical condition; OR,
My spouse or domestic partner has no identifiable community property interest in the benefit, OR,
My spouse or domestic partner and I have executed a marriage settlement or partnership
agreement that makes the community property law inapplicable to the marriage or partnership.
I certify under penalty of perjury that the foregoing information is true and correct.
MEMBER’S SIGNATURE
DATE SIGNED
PERS-BSD-800 (Revised 12/04)
Links to Employee Bargaining Agreements
CSEA Bargaining Agreement
CCFF Bargaining Agreement
What You Need to Know About Your CalPERS
School Benefits
YOUR BENEFITS YOUR FUTURE
Link to CalPERS Handbook