SAN MARCOS UNIFIED SCHOOL DISTRICT

Transcription

1 SAN MARCOS UNIFIED SCHOOL DISTRICT Thank you for applying as a Substitute Teacher for the San Marcos Unified School District! The following documents make up your required new-hire packet. Please complete the top portion of the New Hire Information page carefully. This page will automatically populate many of the fields on the subsequent pages, but you will still need to read each page carefully to ensure that your packet is filled out completely. Please print ALL documents included in the new-hire packet, and be certain to sign all pages, as needed. DO NOT PRINT DOUBLE SIDED You will also need to take the online Mandated Reporter Training. To complete the training, follow this link: Upon successful completion of the training, you will receive an with your Certificate. Please include this Certificate with your New-Hire Packet. REMEMBER TO SCAN AND THE FOLLOWING TO: jenny.veloz@smusd.org Your COMPLETED New-Hire Packet PHOTOCOPY of Signed Social Security Card (no exceptions) PHOTOCOPY of Valid Driver s License PHOTOCOPY of Mandated Reporter Training Certificate ( ed to you after completion) To aid in gathering all documents, please utilize the Checklist that we have provided at the end of the packet. Incomplete packets will delay the hiring process for you.

2 San Marcos Unified School District Human Resources and Development NEW HIRE / EMERGENCY INFORMATION Last Name First Name Middle Street Address City State Zip Home Phone Cell Phone Social Security Number Date of Birth Address Frontline Absence and Substitute Login: Use Home Phone Use Cell Phone Name of Emergency Contact Relation Contact Home Phone Contact Cell Phone Contact Complete Address Signature Date HR USE ONLY Position Orientation Date Start Date Employee # Requisition # Credential Type Master Teacher Expiration Date Site Date Packet Received DL SS TB/ Exp. Date Clearinghouse Verified DB PS Frontline Agenda Sent Married Single Male Female Ethnicity CalSTRS: Yes No CalPERS: Yes No Salary $

3 255 Pico Avenue, Suite 250 San Marcos, CA T F AB 1432 California Educator: Mandated Reporter Training As an employee of the San Marcos Unified School District, you are considered a mandated child abuse reporter. The Child Abuse and Neglect Reporting Act requires a mandated reporter, which includes a teacher or one of certain other types of school employees, to report whenever he or she, in his or her professional capacity or within the scope of his or her employment, has knowledge of or has observed a child whom the mandated reporter knows or reasonably suspects has been the victim of child abuse or neglect. The State Department of Education, in consultation with the Office of Child Abuse Prevention in the State Department of Social Services, has developed an online training module for all persons required to receive the training, and to provide proof of completing the training. As a District employee, you are required to complete the Mandated Reporter Training once each school year. To complete the training, please visit the following website: Upon successful completion of the training, you will receive an with your Certificate. PLEASE BRING IN YOUR COMPLETION CERTIFICATE TO HUMAN RESOURCES WHEN YOU BRING IN YOUR NEW HIRE PACKET Governing Board: Stacy Carlson Victor Graham Pam Lindamood Janet McClean Randy Walton Melissa Hunt, Superintendent

4 Access the SMUSD website at: 1. Under SITE SHORTCUTS in the left column, select Human Resources 2. Click on HR Documents on the left side of the page Review: Safety Manual Substitute Teacher Handbook Annual Notification Package Mandated Reporter Training SMUSD POLICY ACKNOWLEDGEMENT I understand that I am legally obligated to review the following: Annual Notification Packet Safety Manual Substitute Teacher Handbook Mandated Reporter Training on the San Marcos Unified School District website: I understand how to access and have reviewed the district policies / documents listed above First Name (please print) Last Name (please print) Employee Signature Date

5 Substitute Teacher Technology Responsible Use Policy Please read the following carefully. This will give you information about the privileges and responsibilities of using the Internet and district networks, the resources made available by these networks, and all devices connected to these networks. This agreement pertains to all district employees as well as the employees of contracted agencies who will be accessing the Internet or provided with a district login. When using Internet resources for classroom instruction and/or research, substitute teachers/staff have the responsibility to consider the needs, maturity, and ability of their students. Use of the Internet must include being aware of the legal and ethical use of the Internet by minors (please see the Digital Citizenship link on the Educational Technology website for more information). Use of the Internet must be in support of educational research consistent with the educational objectives of San Marcos Unified School District. (Use of another organization s network or computing resources must comply with rules appropriate for that network). General Policies: The purpose of a SMUSD user account is to provide access to the district s network and hosted programs and to facilitate a seamless educational experience promoting 21st century literacy. A content filtering solution is in place to prevent access to sites that may contain inappropriate and/or harmful material including, but not limited to pornography, weapons, illegal drugs, gambling, and sites that pose a security risk. The District monitors its technology systems, including information or files transmitted or stored through the computer systems, voic , text messaging, electronic mail or other technical resources. SMUSD has the right to retrieve and read any message or file. When a message is deleted, it may still be possible to recreate the message; therefore, there should be no expectation of privacy when using district equipment, including the network. The reliability of passwords for maintaining confidentiality cannot be guaranteed. SMUSD Responsible Use Policies apply to users who connect via their own service (cell phones, mobile hotspots, etc.). However, SMUSD cannot be held responsible for the content accessed through these services. The District system is provided on an as-is, as-available basis. The District makes no warranties of any kind related to the use of District computers and network systems. The District shall not be responsible for any damages, losses or costs a staff member suffers in using the Internet and electronic communications. Appropriate Use of Digital Tools and Resources In accordance with our district mission, goals and vision for 21st century learning, our students may require accounts on third-party systems. Many of these accounts will be used at school for school-related projects and accessed outside of school for additional learning. The use of these accounts will help our students to master the effective digital communication and citizenship skills necessary for higher education and the workplace. Teacher who are engaged with students in electronic forms of communication are encouraged to follow standard district guidelines for professional conduct as outlined in the SMUSD Employee Handbook in the Employee Conduct section (page 16). When communicating with students, keep in mind that the time of day, cultural differences, use of informal language or acronyms all can contribute to the interpretation of appropriate contact. Obtaining parental permission for contact, copying parents on messages, and setting hours for contact can all contribute to professional standards for communication with students. Teachers/Staff are expected to uphold reasonable levels of security of their computer equipment and/or district login information in order to ensure the confidentiality of both staff and student records. This includes keeping usernames and passwords confidential. Any user identified as a security risk or having a history of problems

6 with other computer systems may be denied access to the network. Passwords should be changed regularly to help ensure proper security. Attempts to log in to the network using either another user s account or as a network administrator could result in termination of the account. Users should immediately notify a network administrator if a password is lost or stolen, or if they have reason to believe that someone has obtained unauthorized access to their account. Any user identified as a security risk will have limitations placed on usage of the network or may be terminated as a user and be subject to other disciplinary action. The technology equipment, programs, tools, and systems managed by or used at SMUSD may be monitored by designated staff to ensure appropriate use for educational or administrative purposes, including the materials I create, view, copy, or transmit on the system, at any time without notifying me. [Public Records Act ( PRA ) and Title 5, section 16020, et seq., of the California Code of Regulations, pertaining to the retention and destruction of school records] All SMUSD equipment and accounts are for schoolwork only and not for personal use. Copyrighted software or data may not be placed on any system connected to the District's system(s) without permission from the holder of the copyright. Only the owner(s) or individuals specifically authorized may upload copyrighted material to the system(s). No teacher/staff member is authorized to perform maintenance or software installations on any district equipment. Staff members wishing to use personal computers on campus, must verify that equipment is running appropriate and updated virus protection. Equipment not running up-todate anti-virus software may be blocked from the network until it complies. The school district will not provide technical support for personal property, nor will the district install any district owned software on personal property. Responsibilities Staff members should treat all technology devices carefully and report any issues immediately, keep login and password information confidential, and follow all district and school rules, regulations and policies. Staff will also provide access to and/or surrender district-issued equipment to designated staff members upon demand. Prohibited Activities Change, tamper with, or attempt to circumvent any of the school equipment, systems, and security/content filtering measures. This includes, but is not limited to settings, software, downloads, hardware, etc. Access or try to access another person s files, folders, accounts, or work in general Re-use or re-distribute content created by others without their permission or in violation copyright laws. Post or transmit pictures without obtaining prior permission from all individuals depicted or from parents of depicted students who are under the age of 18. Access, post, download, or transmit any "harmful matter material in violation of any federal or state law. This includes, but is not limited to: Any information which violates or infringes upon the rights of any other person; Any fraudulent, defamatory, inappropriate, abusive, obscene, profane, sexually oriented, harassing, threatening, racially offensive, or illegal material; Any information that encourages the use of controlled substances or the use of the system for the purpose of inciting crime. Use logging or tracking software or remote access technology to monitor the network or other user s activity. Consequences Any malicious attempts to harm or destroy District equipment or materials, data of another user of the District's system(s), or any of the agencies or other networks that are connected to the Internet is prohibited. Deliberate attempts to compromise, degrade, or disrupt system performance may be viewed as violations of District policies and administrative regulations and, possibly, as criminal activity under applicable state and federal laws.

7 Unauthorized equipment as well as additions/deletions to the network, network equipment, or software are strictly prohibited. Noncompliance with applicable regulations will result in a) disciplinary action consistent with District policies and regulations; b) revocation of account; c) suspension of access to District technology resources. Violations of law may result in criminal prosecutions as well as disciplinary action by the District. Responsible Use of District Mobile Devices and Loaner Equipment Staff members are expected to uphold reasonable standards of care and security to ensure the safety of loaner equipment. This would entail protecting it from damage from food or drink; and securing the equipment in a locked cabinet or desk when it is not in use. Staff are allowed to use mobile devices off campus, however, they will be responsible for replacement should the equipment be lost, damaged, or stolen when off campus. If transported, it is the employee s responsibility to keep equipment safe and free from damage. This includes locking devices out of sight, in the trunk of your vehicle and not leaving equipment in environments that can cause damage (e.g., hot vehicles, direct sun, moisture, etc.) Equipment is not to be loaned to another staff member, student or family member. Equipment must be returned to school site technical support or other representative upon demand. Repairs are to be done by certified district personnel only and repair charges will include material and labor charges. Replacements are to be obtained through the district from district contracted vendors. Replacement equipment will be of the same type equipment or equivalent, if model in question is no longer available. Loaned equipment remains the property of the San Marcos Unified School District, and the School from which it was issued. Equipment does not become the property of staff to which it is assigned; and is not transferred between schools with staff. I agree to return said equipment upon request. I acknowledge that I will occasionally have to return all equipment assigned to me for routine maintenance and inventory purposes. Substitute Teacher Signature By signing this contract I certify that I have learned the responsibilities of safe and appropriate use of electronic communications systems in SMUSD. I know and understand what I should and should not do, and agree to the terms and conditions of this agreement. I understand that these terms apply to any use of the district equipment and software whether on campus or off, and include the use of personal devices on SMUSD s property and/or network. I agree to install anti-virus software on personal devices and keep it up to date as necessary to prevent damage to District electronic resources. First Name (please print) Last Name (please print) Signature: School/District Site: San Marcos Unified School District Date:

8 Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-9 OMB No Expires 08/31/2019 START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.) Last Name (Family Name) First Name (Given Name) Middle Initial Other Last Names Used (if any) Address (Street Number and Name) Apt. Number City or Town State ZIP Code Date of Birth (mm/dd/yyyy) U.S. Social Security Number Employee's Address Employee's Telephone Number - - I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. I attest, under penalty of perjury, that I am (check one of the following boxes): 1. A citizen of the United States 2. A noncitizen national of the United States (See instructions) 3. A lawful permanent resident (Alien Registration Number/USCIS Number): 4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy): Some aliens may write "N/A" in the expiration date field. (See instructions) Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number. QR Code - Section 1 Do Not Write In This Space 1. Alien Registration Number/USCIS Number: OR 2. Form I-94 Admission Number: OR 3. Foreign Passport Number: Country of Issuance: Signature of Employee Today's Date (mm/dd/yyyy) Preparer and/or Translator Certification (check one): I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1. (Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.) I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct. Signature of Preparer or Translator Today's Date (mm/dd/yyyy) Last Name (Family Name) First Name (Given Name) Address (Street Number and Name) City or Town State ZIP Code Employer Completes Next Page Form I-9 11/14/2016 N Page 1 of 3

9 Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-9 OMB No Expires 08/31/2019 Section 2. Employer or Authorized Representative Review and Verification (Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.") Employee Info from Section 1 Last Name (Family Name) First Name (Given Name) M.I. Citizenship/Immigration Status List A OR List B AND List C Identity and Employment Authorization Identity Employment Authorization Document Title Document Title Document Title Issuing Authority Issuing Authority Issuing Authority Document Number Document Number Document Number Expiration Date (if any)(mm/dd/yyyy) Expiration Date (if any)(mm/dd/yyyy) Expiration Date (if any)(mm/dd/yyyy) Document Title Issuing Authority Additional Information QR Code - Sections 2 & 3 Do Not Write In This Space Document Number Expiration Date (if any)(mm/dd/yyyy) Document Title Issuing Authority Document Number Expiration Date (if any)(mm/dd/yyyy) Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States. The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions) Signature of Employer or Authorized Representative Today's Date(mm/dd/yyyy) Title of Employer or Authorized Representative Human Resources Support Technician Last Name of Employer or Authorized Representative Gagnon First Name of Employer or Authorized Representative Ashley Employer's Business or Organization Address (Street Number and Name) City or Town 255 Pico Ave. Suite 250 San Marcos Employer's Business or Organization Name San Marcos Unified School District State ZIP Code CA Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.) A. New Name (if applicable) B. Date of Rehire (if applicable) Last Name (Family Name) First Name (Given Name) Middle Initial Date (mm/dd/yyyy) C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below. Document Title Document Number Expiration Date (if any) (mm/dd/yyyy) I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual. Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Name of Employer or Authorized Representative Form I-9 11/14/2016 N Page 2 of 3

10 LISTS OF ACCEPTABLE DOCUMENTS All documents must be UNEXPIRED Employees may present one selection from List A or a combination of one selection from List B and one selection from List C. LIST A LIST B LIST C Documents that Establish Both Identity and Employment Authorization OR Documents that Establish Identity AND Documents that Establish Employment Authorization 1. U.S. Passport or U.S. Passport Card 1. Driver's license or ID card issued by a State or outlying possession of the 2. Permanent Resident Card or Alien United States provided it contains a Registration Receipt Card (Form I-551) photograph or information such as name, date of birth, gender, height, eye color, and address 3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machinereadable immigrant visa 4. Employment Authorization Document that contains a photograph (Form I-766) 5. For a nonimmigrant alien authorized to work for a specific employer because of his or her status: a. Foreign passport; and b. Form I-94 or Form I-94A that has the following: (1) The same name as the passport; and (2) An endorsement of the alien's nonimmigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form. 6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI 2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address 3. School ID card with a photograph 4. Voter's registration card 5. U.S. Military card or draft record 6. Military dependent's ID card 7. U.S. Coast Guard Merchant Mariner Card 8. Native American tribal document 9. Driver's license issued by a Canadian government authority For persons under age 18 who are unable to present a document listed above: 10. School record or report card 11. Clinic, doctor, or hospital record 12. Day-care or nursery school record 1. A Social Security Account Number card, unless the card includes one of the following restrictions: (1) NOT VALID FOR EMPLOYMENT (2) VALID FOR WORK ONLY WITH INS AUTHORIZATION (3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION 2. Certification of Birth Abroad issued by the Department of State (Form FS-545) 3. Certification of Report of Birth issued by the Department of State (Form DS-1350) 4. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal 5. Native American tribal document 6. U.S. Citizen ID Card (Form I-197) 7. Identification Card for Use of Resident Citizen in the United States (Form I-179) 8. Employment authorization document issued by the Department of Homeland Security Examples of many of these documents appear in Part 8 of the Handbook for Employers (M-274). Refer to the instructions for more information about acceptable receipts. Form I-9 11/14/2016 N Page 3 of 3

11 OATH OF ALLEGIANCE AND CITIZENSHIP FOR PERSONS EMPLOYED BY A SCHOOL DISTRICT OF THE STATE OF CALIFORNIA (Required by Section 3107 Title 1 Government Code) (State of California, County of San Diego) ss I, do solemnly swear (or affirm) that I will support and defend the Constitution of the United States of American 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 States 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 Taken, subscribed and sworn to before me this day of, 20. Signature of Authorized Official Ashley Gagnon Human Resource Support Technician San Marcos Unified School District San Marcos, CA 92069

12 Form W-4 (2017) Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes. Exemption from withholding. If you are exempt, complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it. Your exemption for 2017 expires February 15, See Pub. 505, Tax Withholding and Estimated Tax. Note: If another person can claim you as a dependent on his or her tax return, you can t claim exemption from withholding if your total income exceeds $1,050 and includes more than $350 of unearned income (for example, interest and dividends). Exceptions. An employee may be able to claim exemption from withholding even if the employee is a dependent, if the employee: Is age 65 or older, Is blind, or Will claim adjustments to income; tax credits; or itemized deductions, on his or her tax return. The exceptions don t apply to supplemental wages greater than $1,000,000. Basic instructions. If you aren t exempt, complete the Personal Allowances Worksheet below. The worksheets on page 2 further adjust your withholding allowances based on itemized deductions, certain credits, adjustments to income, or two-earners/multiple jobs situations. Complete all worksheets that apply. However, you may claim fewer (or zero) allowances. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages. Head of household. Generally, you can claim head of household filing status on your tax return only if you are unmarried and pay more than 50% of the costs of keeping up a home for yourself and your dependent(s) or other qualifying individuals. See Pub. 501, Exemptions, Standard Deduction, and Filing Information, for information. Tax credits. You can take projected tax credits into account in figuring your allowable number of withholding allowances. Credits for child or dependent care expenses and the child tax credit may be claimed using the Personal Allowances Worksheet below. See Pub. 505 for information on converting your other credits into withholding allowances. Nonwage income. If you have a large amount of nonwage income, such as interest or dividends, consider making estimated tax payments using Form 1040-ES, Estimated Tax for Individuals. Otherwise, you may owe additional tax. If you have pension or annuity income, see Pub. 505 to find out if you should adjust your withholding on Form W-4 or W-4P. Two earners or multiple jobs. If you have a working spouse or more than one job, figure the total number of allowances you are entitled to claim on all jobs using worksheets from only one Form W-4. Your withholding usually will be most accurate when all allowances are claimed on the Form W-4 for the highest paying job and zero allowances are claimed on the others. See Pub. 505 for details. Nonresident alien. If you are a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form. Check your withholding. After your Form W-4 takes effect, use Pub. 505 to see how the amount you are having withheld compares to your projected total tax for See Pub. 505, especially if your earnings exceed $130,000 (Single) or $180,000 (Married). Future developments. Information about any future developments affecting Form W-4 (such as legislation enacted after we release it) will be posted at Personal Allowances Worksheet (Keep for your records.) A Enter 1 for yourself if no one else can claim you as a dependent A B Enter 1 if: { You re single and have only one job; or You re married, have only one job, and your spouse doesn t work; or... B } Your wages from a second job or your spouse s wages (or the total of both) are $1,500 or less. C Enter 1 for your spouse. But, you may choose to enter -0- if you are married and have either a working spouse or more than one job. (Entering -0- may help you avoid having too little tax withheld.) C D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return D E Enter 1 if you will file as head of household on your tax return (see conditions under Head of household above).. E F Enter 1 if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit... F (Note: Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.) G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information. If your total income will be less than $70,000 ($100,000 if married), enter 2 for each eligible child; then less 1 if you have two to four eligible children or less 2 if you have five or more eligible children. If your total income will be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter 1 for each eligible child. G H Add lines A through G and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.) H { If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions For accuracy, and Adjustments Worksheet on page 2. complete all If you are single and have more than one job or are married and you and your spouse both work and the combined worksheets earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 that apply. to avoid having too little tax withheld. If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below. Form W-4 Department of the Treasury Internal Revenue Service Separate here and give Form W-4 to your employer. Keep the top part for your records. Employee s Withholding Allowance Certificate Whether you are entitled to claim a certain number of allowances or exemption from withholding is subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS. OMB No Your first name and middle initial Last name 2 Your social security number Home address (number and street or rural route) City or town, state, and ZIP code 3 Single Married Married, but withhold at higher Single rate. Note: If married, but legally separated, or spouse is a nonresident alien, check the Single box. 4 If your last name differs from that shown on your social security card, check here. You must call for a replacement card. 5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 6 Additional amount, if any, you want withheld from each paycheck I claim exemption from withholding for 2017, and I certify that I meet both of the following conditions for exemption. Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and This year I expect a refund of all federal income tax withheld because I expect to have no tax liability. If you meet both conditions, write Exempt here Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete. Employee s signature (This form is not valid unless you sign it.) Date 8 Employer s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.) 9 Office code (optional) 10 Employer identification number (EIN) 5 6 $ For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No Q Form W-4 (2017)

13 Form W-4 (2017) Page 2 Deductions and Adjustments Worksheet Note: Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income. 1 Enter an estimate of your 2017 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state and local taxes, medical expenses in excess of 10% of your income, and miscellaneous deductions. For 2017, you may have to reduce your itemized deductions if your income is over $313,800 and you re married filing jointly or you re a qualifying widow(er); $287,650 if you re head of household; $261,500 if you re single, not head of household and not a qualifying widow(er); or $156,900 if you re married filing separately. See Pub. 505 for details $ 2 Enter: { $9,350 if head of household } $ $12,700 if married filing jointly or qualifying widow(er) $6,350 if single or married filing separately 3 Subtract line 2 from line 1. If zero or less, enter $ 4 Enter an estimate of your 2017 adjustments to income and any additional standard deduction (see Pub. 505) 4 $ 5 Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to Withholding Allowances for 2017 Form W-4 worksheet in Pub. 505.) $ 6 Enter an estimate of your 2017 nonwage income (such as dividends or interest) $ 7 Subtract line 6 from line 5. If zero or less, enter $ 8 Divide the amount on line 7 by $4,050 and enter the result here. Drop any fraction Enter the number from the Personal Allowances Worksheet, line H, page Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet, also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1 10 Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.) Note: Use this worksheet only if the instructions under line H on page 1 direct you here. 1 Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet) 1 2 Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more than If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter -0- ) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet Note: If line 1 is less than line 2, enter -0- on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional withholding amount necessary to avoid a year-end tax bill. 4 Enter the number from line 2 of this worksheet Enter the number from line 1 of this worksheet Subtract line 5 from line Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here $ 8 Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed.. 8 $ 9 Divide line 8 by the number of pay periods remaining in For example, divide by 25 if you are paid every two weeks and you complete this form on a date in January when there are 25 pay periods remaining in Enter the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck 9 $ Table 1 Table 2 Married Filing Jointly All Others Married Filing Jointly All Others If wages from LOWEST paying job are Enter on line 2 above If wages from LOWEST paying job are Enter on line 2 above If wages from HIGHEST paying job are Enter on line 7 above If wages from HIGHEST paying job are Enter on line 7 above $0 - $7,000 0 $0 - $8,000 0 $0 - $75,000 $610 $0 - $38,000 $610 7,001-14, ,001-16, , ,000 1,010 38,001-85,000 1,010 14,001-22, ,001-26, , ,000 1,130 85, ,000 1,130 22,001-27, ,001-34, , ,000 1, , ,000 1,340 27,001-35, ,001-44, , ,000 1, ,001 and over 1,600 35,001-44, ,001-70, ,001 and over 1,600 44,001-55, ,001-85, ,001-65, , , ,001-75, , , ,001-80, , , ,001-95, ,001 and over 10 95, , , , , , , , ,001 and over 15 Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person who claims no withholding allowances; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return. If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.

14 PRINT or TYPE NAME San Marcos Unified School District DIRECT DEPOSIT AUTHORIZATION SOCIAL SECURITY NO./EMPLOYEE ID NO. DISTRICT WORK SITE Do you currently have an active Direct Deposit on file with another District or Charter School within San Diego County? Yes No If yes, what District(s) and/or Charter School(s)? I hereby authorize the above named School District(s), Charter School(s), and the San Diego County Office of Education (SDCOE) and/or their agents to initiate electronic deposits via the Automated Clearing House (ACH) and, as necessary, to debit corrections to previous deposits, to the account(s) specified below. Direct deposit status is not activated until my regular payroll cycle following a $0 test transaction (approx. 30 days). I must submit a new authorization form if I close/change my account (name, branch, etc.). Failure to do so may result in in a deposit delay. All new accounts must go through a Prenote verification (approx. 30 days), during which time a live warrant will be issued. Direct deposit status will be temporarily suspended if wages are garnished and/or the Credentials Unit at SDCOE places a hold on the warrant. It is my responsibility to keep apprised of any deposit(s) made to my account(s), including the date(s) and amount(s) of any such deposit(s). S n/a I agree to hold harmless and indemnify the School District(s), Charter School(s), and SDCOE and their officers, employees, and agents from any claim or demand of whatever nature, including those based upon negligence of the District, School, or SDCOE and their officers, employees, and agents for failure or delay in making deposits and/or corrections to deposits as herein authorized. This authorization replaces any previous agreements made by me and will remain in effect until changed or canceled by submission of a new Direct Deposit Authorization to the District, School, or SDCOE office in which I am currently employed. All District, School, and SDCOE assignments, both current and future, will automatically be linked to the most recent Direct Deposit Authorization received by my current employer(s). Signature: Date: DEPOSIT INSTRUCTIONS: q New ACH Set Up q ACH Amount Change q (Prenote Needed) (No Prenote needed) ACH Cancellation Name of Financial Institution Address of Financial Institution Financial Institution T ransit R outing No. Checking Savings Net Check, or $ Net Check, or $ Checking Account Number Savings A ccount Number ATTACH VOIDED, BLANK CHECK HERE, IF DEPOSITING TO A CHECKING OR SHARE DRAFT ACCOUNT Jane A. Doe 1000 Main St. Anywhere, U.S.A Pay t o the O r der of $ doll ar s me mo T ransit R outing No. Account No. Check No. FORM BU S SDCOE 1/15 Payroll/HR Use Only: If applicable - Payroll/HR Department has notified other District and/or Charter School of Direct Deposit update on Date Initials

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16 Human Resources and Development 255 Pico Avenue, Suite 250 San Marcos, CA T F HUMAN RESOURCES AND DEVELOPMENT VOLUNTARY INFORMATION FORM Section 1233 of the California Government Code permits public employers to solicit from employees and applicants a voluntary declaration of sex and racial/ethnic group membership. Information provided will assist the San Marcos Unified School District (SMUSD) in accurately compiling required statistical reports for federal and state agencies. None of the information will be used to discriminate against or give preference to any individual in any personnel transaction. Other information requested is for the SMUSD use only and is also voluntary. PLEASE PRINT Full legal name: Position: Substitute Teacher Birthdate: School site/work location: Gender: San Marcos Unified School District The following questions are required to be in compliance with new Federal/State laws. Please mark the appropriate area: Ethnic Background: Are you Hispanic or Latino? NO YES Please continue to answer the following by marking one or more to indicate your race: Alaskan Native Chinese Hmong Other Asian Vietnamese American Indian Filipino Japanese Other Pacific Islander White Black/African American Guamanian Korean Samoan Cambodian Hawaiian Laotian Tahitian Governing Board: Stacy Carlson Victor Graham Pam Lindamood Janet McClean Randy Walton Melissa Hunt, Superintendent

17 Human Resources and Development 255 Pico Avenue, Suite 250 San Marcos, CA T F Retirement System and Social Security System Disclosures Please complete, sign and date Are you currently, or have you been, a member of CALPERS (California Public Employee Retirement System)? Are you receiving a CALPERS pension payment? Are you currently, or have you been, a member of CALSTRS (California State Teachers Retirement System)? Are you receiving a CALSTRS pension payment? Are you receiving Social Security Retirement benefits? Print Employee Name Employee Signature Date Governing Board: Stacy Carlson Victor Graham Pam Lindamood Janet McClean Randy Walton Melissa Hunt, Superintendent

18 ,, Substitute Teacher

19 Retirement System Election ES0372 (rev 07/16) California State Teachers Retirement System P.O. Box 15275, MS 17 Sacramento, CA CalSTRS.com PLEASE READ THE ATTACHED INFORMATION AND INSTRUCTIONS BEFORE COMPLETING THIS FORM. PLEASE TYPE OR PRINT LEGIBLY IN DARK INK. RETIREMENT SYSTEM ELECTION AND ACKNOWLEDGEMENT OF RECEIPT OF RETIREMENT SYSTEM INFORMATION SECTION 1: MEMBER INFORMATION AND ELECTION (to be completed by employee) NAME (LAST, FIRST, INITIAL) FULL SOCIAL SECURITY NUMBER HIRE DATE EFFECTIVE DATE OF POSITION POSITION TITLE Credentialed Classified State Service A member of CalSTRS who becomes employed in a new position by the same or a different school district, a community college district, a county superintendent of schools, limited state employment or the Board of Governors of the California Community Colleges, as defined in Education Code sections and , to perform service that requires membership in a different public retirement system will have that service credited with that other public retirement system unless he/she files a written election (within 60 days after the date of hire) to have that service covered by CalSTRS, pursuant to Education Code section 22508(a) or (a). I am a member of CalSTRS who has accepted employment to perform service that requires membership in a different public retirement system and am eligible to elect to continue retirement system coverage under CalSTRS. I elect coverage in: (please choose one), Substitute Teacher OR X A member of CalPERS who is employed by a school employer, Board of Governors of Community College Districts or State Department of Education or who has at least five years of CalPERS credited service, as defined in Government Code section 20309, and who subsequently becomes employed to perform creditable service that requires membership in CalSTRS, will have that service credited with CalSTRS unless he/she files a written election (within 60 days after the date of hire) to have the service credited with CalPERS, pursuant to Government Code section I am a member of CalPERS who has accepted employment to perform service that requires membership in CalSTRS Defined Benefit Program, and am eligible to elect to continue coverage under CalPERS. I elect coverage in: (please choose one) CA State Teachers Retirement System (CalSTRS) CA Public Employee s Retirement System (CalPERS) * CA State Teachers Retirement System (CalSTRS) CA Public Employee s Retirement System (CalPERS) * Other: With my signature below, I certify that I have received information from my employer regarding my eligibility to elect membership for this position as described on this form. I fully understand that this election is irrevocable. I understand it is a crime to fail to disclose a material fact or to make any knowingly false material statements for the purpose of altering a benefit administered by CalSTRS and it may result in up to one year in jail and a fine of up to $5,000. (Education Code section 22010). EMPLOYEE SIGNATURE DATE SECTION 2: EMPLOYER CERTIFICATION (to be completed by employer and County Office of Education) With my signature below, I certify that I have provided information to the employee regarding his/her eligibility to elect membership for this position, pursuant to Education Code section I certify the employee meets the qualifications to make a retirement system election, pursuant to Education Code sections or , or Government Code section SAN DIEGO COUNTY / SAN MARCOS UNIFIED SCHOOL DISTRICT CO/DIST/STATE DEPT NAME CALSTRS REPORT UNIT CODE PRISCILLA MADRID LOPEZ HUMAN RESOURCES DATA TECHNICIAN (760) SCHOOL/STATE OFFICIAL'S NAME TITLE PHONE NUMBER SIGNATURE OF SCHOOL/STATE OFFICIAL DATE COUNTY OFFICIAL'S NAME TITLE PHONE NUMBER SIGNATURE OF COUNTY OFFICIAL *CalPERS Employer Code: RETIREMENT SYSTEM ELECTION FORM REV 07/16 PAGE 1 OF 1

20 Retirement System Election Information and Instructions The following instructions are to assist you and your employer in completing the Retirement System Election form (ES372). Please read the instructions and information for retirement system coverage before completing the form. Please type or print legibly in dark ink. Do not use light colors of ink, pencil, felt pen, or erasable ink. If you should make a mistake on the form, line through the error and initial. INFORMATION A member of the CalSTRS Defined Benefit Program who becomes employed by a school district, a community college district, a county superintendent of schools or limited state departments to perform service that requires membership in a different public retirement system, may elect to receive credit under the CalSTRS Defined Benefit Program for such service by submitting a Retirement System Election form (ES372) to CalSTRS, within 60 days of the effective date of employment in the position requiring membership in the other system. If the CalSTRS member does not elect to continue as a member of CalSTRS, all service subject to coverage by the other public retirement system will be reported to that retirement system. (Education Code section 22508) A member of CalPERS who was employed by a school employer, Board of Governors of California Community Colleges, or State Department of Education or has at least five years of CalPERS credited service and who accepts employment to perform creditable service that requires membership by the CalSTRS Defined Benefit Program, may elect to receive credit under CalPERS for such service by submitting a Retirement System Election form (ES372) to CalPERS, within 60 days of the effective date of employment in the position requiring membership in the other system. If the CalPERS member does not elect to continue as a member of CalPERS, all CalSTRS creditable service will be reported to CalSTRS. (Government Code section 20309). SECTION 1: MEMBER INFORMATION AND ELECTION Section 1 of the form must be completed by the employee with assistance from the employer. Please complete all entries in Section 1. Keep a copy of the form for your records. EMPLOYEE NAME and SOCIAL SECURITY NUMBER Enter employee s full name, and full Social Security Number. HIRE DATE Enter the date the employee was hired in the position. EFFECTIVE DATE OF POSITION - Enter the effective date of the new position. This is the first date that service was/will be performed by the employee in the new position. POSITION TITLE Enter employee s new position title and check the box next to the applicable position type. RETIREMENT SYSTEM COVERAGE: If you are a member of CalSTRS and have accepted employment to perform service that requires membership in a different public retirement system, enter an X in the box next to the coverage you elect. If you are a member of CalPERS and have accepted employment to perform service that requires membership in CalSTRS, enter an X in the box next to the coverage you elect. EMPLOYEE SIGNATURE Sign and date the Retirement System Election form (ES372). By signing this document, you understand this election is irrevocable for this employer, and that it is a crime to fail to disclose a material fact or to make any knowingly false material statements for the purpose of altering a benefit administered by CalSTRS and it may result in up to one year in jail and a fine of up to $5,000. (Education Code section 22010) Submit the signed and dated Retirement System Election form (ES372) to your employer. Retain a copy for your records. For further information, contact CalSTRS by calling , or write to CalSTRS at P.O. Box 15275, MS 17, Sacramento, CA SECTION 2: EMPLOYER CERTIFICATION Section 2 of the form must be completed by the employer and the County Office of Education. Please complete the employer certification only after the employee has completed Section 1. Employees must qualify for membership before they can elect. EMPLOYER: CO/DIST CODE/STATE DEPARTMENT Enter the appropriate county and district codes. Example: Kern County, Edison Elementary would be , CA Department of Education EMPLOYER CERTIFICATION Print school or state official s name, title and phone number, sign and date the Retirement System Election form (ES372). Submit the completed Retirement System Election form (ES 372) to the County Office of Education or if you represent a state department, send it directly to CalSTRS and send a copy to the other public retirement system. COUNTY OFFICE OF EDUCATION: Review, sign and date the Retirement System Election form (ES372). Mail the original Retirement System Election form (ES372) form to the retirement system elected by the employee and a copy to the retirement system that would normally cover the service. Provide copies for the employer, employee and employee s file. RETIREMENT SYSTEM ELECTION INFORMATION AND INSTRUCTIONS REV 11/13 PAGE 1 OF 1