New Employee Driver History (DMV) Authorization As per The Fair Credit Reporting Act, Pennridge School District must obtain a signature from each potential new employee. By signing below this will allow Pennridge School District to request a report of your driving record for the last ten (10) years.
I authorize Pennridge School District to request a DMV record check:
_______________________________________ Signature
__________________ Date
________________________________________ Print Name
Please include your driver’s license number: _____________
C:\Users\E01602\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\71NSGDHQ\Driver History - new employee.doc
H511.340 (Rev. 4/00)
Position ____________________________
COMMONWEALTH OF PENNSYLVANIA PENNSYLVANIA DEPARTMENT OF HEALTH
SCHOOL PERSONNEL HEALTH RECORD I. Patient Information
Last Name
First
MI
Social Security Number
Sex
Date of Birth
Home Telephone
Work Telephone
Mailing Address
Street
City
State
Usual Source of Medical Care
Physician’s Name
Address
Telephone
Address
Telephone
Emergency Contact – Name
Relationship
Zip
II. Immunization History (Preferred; Not Required) Enter Month, Day, and Year Each Immunization was Given
DOSES
VACCINE
BOOSTERS & DATES
Diphtheria and Tetanus*
1.
2.
3.
4.
Hepatitis B
1.
2.
3.
Measles, Mumps, Rubella
1.
2.
Other ________________
1.
Other _____________________
5.
1.
* Tetanus and Diphtheria are usually received in combined vaccines such as DTP, DtaP, DT, or Td
III. Required Tuberculosis Test Results (as per Regulations of the Department of Health DATE APPLIED
DATE READ
ARM
METHOD
ANTIGEN
RESULTS (mm)
MANUFACTURER
SIGNATURE
SIGNATURE
For previously known/new positive reactors: _______________________________________________________________________ Chest X-ray: Date: ____________ (Attach a copy of the report.)
Results: _____________
Preventive Anti-Tuberculosis Chemotherapy ordered:
F No
Other: Date: _____________ (Attach a copy of the report.) F Yes
Results: _______________
Date: ______________
IF SIGNIFICANT REACTION WAS REPORTED, THE PHYSICIAN REPORT MUST STATE THAT THE APPLICANT IS FREE FROM CURRENT TUBERCULOSIS DISEASE OR IS UNDER ADEQUATE CHEMOTHERAPY FOR TUBERCULOSIS DISEASE: ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________
School Personnel Health Record Section II -- Immunization History is NOT required. Section III -- TB test IS required. We can accept a TB test (Mantoux) that has been given within the last 90 days.
IV. Significant Medical Conditions (9)
Allergies ........................................... Asthma .............................................. Cardiac .............................................. Chemical Dependency ...................... Drugs............................................ Alcohol......................................... Diabetes Mellitus .............................. Gastrointestinal Disorder .................. Hearing Disorder............................... Hypertension ..................................... Neuromuscular Disorder ................... Orthopedic Condition........................ Respiratory Illness............................. Seizure Disorder................................ Skin Disorder .................................... Vision Disorder................................. Other (Specify)..................................
Yes F F F F F F F F F F F F F F F F F
No F F F F F F F F F F F F F F F F F
If Yes, Explain: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________
V. Report of Physical Examination (9) NORMAL
ABNORMAL
NOT EXAMINED
COMMENTS
Height (inches) ______________ Weight (pounds) ______________ Pulse _____________ Blood Pressure ______________ Hair/Scalp Skin Eyes – Visual Acuity: R _____ L _____ Eyes – Color Vision Ears – Hearing (dB) R _____ L _____ Nose and Throat Teeth and Gingiva Lymph Glands Heart – Murmur, etc… Lungs – Adventitous Findings Abdomen Genitourinary Neuromuscular System Extremities
Are there any special medical problems or chronic diseases which require restriction of activity, medication or which might affect his/her work role? If so, specify __________________________________________________________________________________
____________________________________________ Physician Name (Print)
__________________________________________________ Signature of Examiner
___________________ Date
______________________________________________________________________________________________________________________________ Physician Address The statements and answers as recorded above are full, complete and true to the best of my knowledge and belief. I understand that any false or misleading statements may cause termination of my employment. I authorize the physician or other person to disclose any knowledge or information pertaining to my health to the employing authority for whom this examination is performed. _________________________________________ Signature of Employee
_____________________ Date
NEW EMPLOYEE PERSONNEL INFORMATION QUESTIONNAIRE ____________________ PDE PPID #
Social Security Number
Mr.,Ms.,Mrs. or Miss
First Name
Middle Initial
Last Name
Maiden Name
Street Address
Home Phone
City
State
Zip Code
Birthdate:
4 - Hispanic
Cell Phone
Month / Day / Year
Circle correct response to following:
Race: Sex: Marital Status: Educational Level:
(Highest Level Completed)
Educational Institution(s) Attended:
1 - American Indian/Alaskan Native Male Single
2 - Asian or Pacific Islander Female Married
3 - Black / African American(not Hispanic)
Less than High School
High School Graduate
Less than Bachelors
(any race)
5 – White / Caucasian (not Hispanic)
Divorced
Name
BA/BS
Additional Credits after BA/BS
Degree
MA
Doctorate
Date
Certificate(s) Held: Years of Teaching Experience: Emergency Information:
# of years teaching Out of State:
# of years teaching In PA:
Contact
Relationship
Telephone
Doctor’s Name
Phone
Hospital
0B
6 – MultiRacial
Revised 3/3/2008 – h:kkriebel/Forms-Personnel/New Employee Personnel Information Questionnaire
Total Years: √if unlisted
No. 815
PENNRIDGE SCHOOL DISTRICT
SECTION:
OPERATIONS
TITLE:
ACCEPTABLE USE OF INTERNET, COMPUTERS AND NETWORK RESOURCES
ADOPTED:
March 17, 1997
REVISED:
May 21, 2012
815. ACCEPTABLE USE OF INTERNET, COMPUTERS AND NETWORK RESOURCES 1. Purpose
The Board of School Directors recognizes the important role that computers and other forms of technology play in a student’s education and in the pursuit of the district’s educational goals. The Board, therefore, has authorized the Superintendent or his/her designee to make available computing and networked information resources such as the Internet which may be used by district students, faculty, and staff. These resources, however, are intended to be used solely for educational purposes and to carry out the legitimate business of the district. The use of networked facilities shall be consistent with the curriculum adopted by the district as well as the varied instructional needs, learning styles, abilities and developmental levels of students.
2. Authority 47 U.S.C. Sec. 254 Pol. 218, 233, 317
The use of these resources by students, faculty and staff is considered a privilege which may be denied for inappropriate and/or illegal use as set forth in this and related policies. Furthermore, violations of the guidelines set forth by the district or other improper use of these resources may result in disciplinary action in accordance with established disciplinary procedures for students, faculty and staff. The Board expects all students, faculty and staff to be law-abiding citizens, to respect the rights of others, and to refrain from behavior which tends to impair the district’s purpose or its reputation within the community. The framework of responsible, considerate and ethical behavior expected by the district, as set forth in policy and guidelines, covers the use of district microcomputers, workstations, computing laboratory facilities, general access timesharing systems, and network and networked resources. The electronic information available to and prepared by students, faculty and staff does not imply endorsement of the content by the district nor does the district guarantee the accuracy of information received on the Internet.
Page 1 of 4
815. ACCEPTABLE USE OF INTERNET, COMPUTERS AND NETWORK RESOURCES - Pg. 2
Pol. 801
The district reserves the right to log network use and to monitor fileserver space utilization by all district users. Accordingly, system users possess no privacy expectation in the contents of their personal files and/or e-mail on the district system. Specifically, routine maintenance and monitoring of the system may lead to discovery that the user has or is violating this or other policies of the district and/or the law of the United States of America or the Commonwealth of Pennsylvania. Moreover, an individual search will be conducted if there is reasonable suspicion that a user has violated the law or the district’s policies. Finally, district employees should be aware that their personal files may be discoverable under state public records law. Use of these resources as well as any information obtained via the Internet is at the user’s own risk. The district makes no warranties of any kind, either expressed or implied, that the functions or the services provided by or through the district system is error-free or without defect. Specifically, the district is not responsible for any damage users may suffer, including, but not limited to, loss of data or interruptions of services. The district also is not responsible for the accuracy or quality of information obtained through or stored on the system. Finally, the district is not responsible for any financial obligations arising from the unauthorized use of the system.
3. Delegation of Responsibility 24 P.S. Sec. 4604
The district shall make every effort to ensure that this educational resource is used responsibly by students, faculty and staff, including, but not limited to, taking every reasonable step to control access to material inappropriate to the educational mission of the district.
Pol. 105.2
The Superintendent or designee has the responsibility of developing administrative guidelines and forms governing use of the district network to include, but not be limited to, (i) the establishment of “User Contracts” and/or individual accounts; (ii) procedures by which parents will be notified of the particulars of the district network and the policies governing its use; (iii) procedures by which parents, in accordance with Chapter 4 of the Pennsylvania Code may have their child(ren) excused from specific instruction which conflicts with their religious beliefs; (iv) procedures/policies designed to attempt to ensure personal safety while using the Internet; and (v) prohibitions against use of the network for such activities as fundraising and/or personal commercial or financial gain, political campaigning/lobbying, unlawful purposes, or for any other purpose inconsistent with the educational mission of the district.
SC 1303.1-A Pol. 249
Administrators, teachers and staff have a professional responsibility to work together to help students develop the intellectual skills necessary to discriminate among information sources, to identify information appropriate to their age and developmental levels, and to evaluate and use the information to meet their
Page 2 of 4
815. ACCEPTABLE USE OF INTERNET, COMPUTERS AND NETWORK RESOURCES - Pg. 3
educational goals. The school district will educate all students about appropriate online behavior, including interacting with other individuals on social networking websites and in chat rooms, and about cyberbullying awareness and response. Students, faculty and staff have the responsibility to respect and protect the rights of every other user in the district and on the Internet. Students and staff are expected to act in a responsible, ethical and legal manner in accordance with district policy and procedures, accepted rules of network etiquette, and federal and state law. 20 U.S.C. Sec. 6777 47 U.S.C. Sec. 254 47 CFR Sec. 54.520
District procedures shall include but are not limited to: 1. Utilizing a technology protection measure that blocks or filters Internet access for minors and adults to certain visual depictions that are obscene, child pornography, or otherwise inappropriate or harmful to minors. 2. Maintaining and securing a usage log. 3. Monitoring online activities of minors. Safety
47 U.S.C. Sec. 254 47 CFR Sec. 54.520
Internet safety measures shall effectively address the following: 1. Control of access by minors to inappropriate matter on the Internet and World Wide Web. 2. Safety and security of minors when using electronic mail, chat rooms, and other forms of direct electronic communications. 3. Prevention of unauthorized online access by minors, including "hacking" and other unlawful activities. 4. Unauthorized disclosure, use, and dissemination of personal information regarding minors. 5. Restriction of minors’ access to materials harmful to them.
Page 3 of 4
815. ACCEPTABLE USE OF INTERNET, COMPUTERS AND NETWORK RESOURCES - Pg. 4
4. Guidelines
Consequences The consequences for inappropriate use, including those consequences set forth by contract or district policy, are as follows: 1. The user shall be financially responsible for all costs associated with damage to hardware, systems and software resulting from deliberate or willful acts.
24 P.S. Sec. 4604 Pol. 814
2. The user will be reported to the appropriate legal authorities for possible prosecution for vandalism to the hardware, systems and software; illegal use of the network; intentional deletion or damage to files of data belonging to the district or others; copyright infringement; theft or services; etc. 3. Access privileges may be suspended for a specified period of time, including permanently, as determined by the Superintendent or his/her designee.
References: School Code – 24 P.S. Sec. 1303.1-A Child Internet Protection Act – 24 P.S. Sec. 4601 et seq. U.S. Copyright Law – 17 U.S.C. Sec. 101 et seq. Enhancing Education Through Technology Act – 20 U.S.C. Sec. 6777 Internet Safety, Children’s Internet Protection Act – 47 U.S.C. Sec. 254 Children’s Internet Protection Act Certifications, Title 47, Code of Federal Regulations – 47 CFR Sec. 54.520 Board Policy – 103, 103.1, 104, 105.2, 218, 218.2, 233, 248, 249, 317, 348, 801, 814
Page 4 of 4
PENNRIDGE SCHOOL DISTRICT’S COMPUTING AND INFORMATION SYSTEMS USER GUIDELINES OVERVIEW The Acceptable Use Policy for the District’s computing and networked information systems adopted by the Board of School Directors defines the District’s position regarding the use by students and staff members of its computing and information systems, as well as Internet–based applications. The following guidelines are based on that policy and establish standards to acceptable use of all District computers, computer networks, information systems and Internet connections by staff. The guidelines provide a means by which the Administration will regulate staff use of the District’s computing and information systems. The Pennridge School District’s computing and information systems are provided for a specific, limited purpose: to enhance the delivery of education. Consequently, the use of District computing and information systems shall be restricted to educational purposes, i.e., activities directly connected to, and which are a direct result of, the established school curriculum and/or the management of the school district. All staff members shall follow all regulations and meet all standards as set forth in this document. Failure to do so may result in loss of access privileges and/or other disciplinary action (see “Consequences”). RESPONSIBILITIES The District is responsible for defining reasonable boundaries for acceptable use of the District’s computing and informational system(s); educating students, staff and other users about the acceptable uses; providing general supervision; and enforcing the policies for acceptable use. The District cannot be responsible for direct supervision of every student or other user while they are using the Internet. The District will, however, make every attempt to provide a safe and secure computing and information management system for its users. Teachers, within the reasonable scope of instructional responsibilities and/or assigned duties, are responsible for instructing students on the proper use of computing and information systems and ensuring that all students understand and follow district usage guidelines and rules. Parents are responsible for providing their children with direction regarding restrictions above and beyond those imposed by the District. If the child has access to District/county/state/nation dial-up service from the home as part of the computing and information systems is predicated upon completion of a signed User Agreement. Parents are also responsible for reinforcing the provisions of the User Agreement. Individual users are granted permission to use the District’s computing and networked information system(s) only by officials of the District. Individuals are responsible for obtaining permission to use the District’s computing and information systems and to complete and sign a User Agreement. Students are required to submit and resubmit a signed User Agreement upon entering elementary, middle, and high school. Individuals who do not have permission to use one or more of the District’s computers and who do not sign and return a User Agreement shall not use or attempt to use any District computer or information system. All individual users are expected to act in a responsible, ethical and legal manner in accordance with District policy, accepted rules of network etiquette, and Federal and state law. Specifically, the following are prohibited: 1. Obtaining system privileges to which one is not authorized. 2.
Deliberately attempting to disrupt the performance of the District’s computer system(s) or to destroy data by spreading computer viruses or by any other means.
3.
Use of any District computer, information system, or District–provided Internet–based application, to facilitate, advocate, condone or participate in illegal activities.
4.
Use of any District computer, information system, or District–provided Internet–based application, for personal or private commercial or financial gain.
5.
Use of any District computer, information system, or District–provided Internet–based application, to make unauthorized purchases of products and/or services inconsistent with current District purchasing policies and procedures.
6.
Use of any District computer, information system, or District–provided Internet–based application, for non-school related work.
7.
Use of any District computer, information system, or District–provided Internet–based application, for non-school related fund-raising.
9/3/11
8.
Use of any District computer, information system, or District–provided Internet–based application, for political campaigning and/or lobbying.
9.
Use of inappropriate language on any District computer or information system including, but not limited to, that which is obscene, profane, lewd, vulgar, rude, disrespectful, threatening or inflammatory as determined by the appropriate supervisor.
10. Use of any District computer, information system, or District–provided Internet–based application, for hate mail, discriminatory remarks and false or defamatory material about a person or group. 11. Displaying or generating images, sounds or messages (on screen, computers or printers) which could create an atmosphere of discomfort, intimidation or harassment to others. 12. Violations of privacy including, but not limited to, revealing personal information about others. 13. Use of any District computer, information system, or District–provided Internet–based application, to disrupt the work of others such as, but not limited to, intentionally obtaining or modifying files, passwords and/or data belonging to other users. 14. Unauthorized use of a network address, use of pseudonyms or anonymous use. 15. Copyright infringement or plagiarism, students, staff and other users should assume that all works, including, but not limited to Web designs, on the Internet are protected by the copyright laws, and thus, should make every attempt to request permission from the creator of the same to use this work. 16. Loading or use of unauthorized, as determined by the District Technology Coordinator or his/her designee, software, games, programs, files or other electronic media. 17. Creating and sending or forwarding electronic chain letters. 18. “Spamming” which is sending an annoying, unnecessary and /or unsolicited electronic message. 19. Actions which constitute the unauthorized copying, cross-assembling or reverse-compiling of programs and data provided by the District. 20. Destruction, modification, abuse or removal from the District of any piece of computer hardware, software or network system. 21. Wastefully using finite resources such as, paper, ink, and electronic memory resources. 22. Posting of (for) unauthorized or inappropriate use personal contact information about themselves or others including, but not limited to name, home address, school address, work address, home telephone number, work telephone number, etc.
CONSEQUENCES 1. The user shall be financially responsible for all costs associated with damage to hardware, systems and software resulting from deliberate or willful acts. 2.
The user will be reported to the appropriate legal authorities for possible prosecution for vandalism of any hardware, systems or software; intentional deletion or damage to files or data belonging to the District or others; copyright infringement or theft of services, etc.
3.
Access privileges may be suspended for a specific period of time, including permanently, as determined by the Superintendent and/or his/her designee.
4.
Students may be suspended or expelled, including permanently, for violations of the district’s Acceptable Use Policy and the guidelines promulgated thereunder.
9/3/11
Pennridge School District Staff Computer and Information Systems User Agreement Staff Member Name: Position: Building(s): As an employee of the Pennridge School District, I recognize and understand that, by providing access to the District’s computing and networked information systems, the District requires all employees to use such systems in accordance with the Acceptable Use Policy and the Guidelines promulgated thereunder. I acknowledge that I have received, read and understood the District’s Acceptable Use Policy and the Guidelines promulgated thereunder. Signature:
PSD_ComputerUserAgreement
Date:
March 5, 2011
1 of 3
ARREST/CONVICTION REPORT AND CERTIFICATION FORM (under Act 24 of 2011 and Act 82 of 2012) Section 1.
Personal Information
Full Legal Name: Date of Birth: _____/_____/________ Other names by which you have been identified: Section 2.
Arrest or Conviction
By checking this box, I state that I have NOT been arrested for or convicted of any Reportable Offense.
By checking this box, I report that I have been arrested for or convicted of an offense or offenses enumerated under 24 P.S. §§1-111(e) or (f.1) (“Reportable Offense(s)”). See Page 3 of this Form for a list of Reportable Offenses. Details of Arrests or Convictions For each arrest for or conviction of any Reportable Offense, specify in the space below (or on additional attachments if necessary) the offense for which you have been arrested or convicted, the date and location of arrest and/or conviction, docket number, and the applicable court. _______________________________________________________________________________ _______________________________________________________________________________
Section 3.
Child Abuse
By checking this box, I state that I have NOT been named as a perpetrator of a founded report of child abuse within the past five (5) years as defined by the Child Protective Services Law.
By checking this box, I report that I have been named as a perpetrator of a founded report of child abuse within the past five (5) years as defined by the Child Protective Services Law. Section 4.
Certification
By signing this form, I certify under penalty of law that the statements made in this form are true, correct and complete. I understand that false statements herein, including, without limitation, any failure to accurately report any arrest or conviction for a Reportable Offense, shall subject me to criminal prosecution under 18 Pa.C.S. §4904, relating to unsworn falsification to authorities.
Signature
Date
PDE-6004 03/01/2016
2 of 3
INSTRUCTIONS Pursuant to 24 P.S. §1-111(c.4) and (j), the Pennsylvania Department of Education developed this standardized form (PDE-6004) to be used by current and prospective employees of public and private schools, intermediate units, and area vocational-technical schools. As required by subsection (c.4) and (j)(2) of 24 P.S. §1-111, this form shall be completed and submitted by all current and prospective employees of said institutions to provide written reporting of any arrest or conviction for an offense enumerated under 24 P.S. §§1-111(e) and (f.1) and to provide notification of having been named as a perpetrator of a founded report of child abuse within the past five (5) years as defined by the Child Protective Services Law. As required by subsection (j)(4) of 24 P.S. §1-111, this form also shall be utilized by current and prospective employees to provide written notice within seventy-two (72) hours after a subsequent arrest or conviction for an offense enumerated under 24 P.S. §§1-111(e) or (f.1). In accordance with 24 P.S. §1-111, employees completing this form are required to submit the form to the administrator or other person responsible for employment decisions in a school entity. Please contact a supervisor or the school entity administration office with any questions regarding the PDE 6004, including to whom the form should be sent.
PROVIDE ALL INFORMATION REQUIRED BY THIS FORM LEGIBLY IN INK.
PDE-6004 03/01/2016
3 of 3
LIST OF REPORTABLE OFFENSES
A reportable offense enumerated under 24 P.S. §1-111(e) consists of any of the following:
(1) (2)
An offense under one or more of the following provisions of Title 18 of the Pennsylvania Consolidated Statutes:
Section 4304 (relating to endangering welfare of children) Section 4305 (relating to dealing in infant children) A felony offense under section 5902(b) (relating to prostitution and related offenses) Section 5903(c) or (d) (relating to obscene and other sexual materials and performances) Section 6301(a)(1) (relating to corruption of minors) Section 6312 (relating to sexual abuse of children) Section 6318 (relating to unlawful contact with minor) Section 6319 (relating to solicitation of minors to traffic drugs) Section 6320 (relating to sexual exploitation of children) An offense designated as a felony under the act of April 14, 1972 (P.L. 233, No. 64), known as “The Controlled Substance, Drug, Device and Cosmetic Act.” Chapter 25 (relating to criminal homicide) Section 2702 (relating to aggravated assault) Section 2709.1 (relating to stalking) Section 2901 (relating to kidnapping) Section 2902 (relating to unlawful restraint) Section 2910 (relating to luring a child into a motor vehicle or structure) Section 3121 (relating to rape) Section 3122.1 (relating to statutory sexual assault) Section 3123 (relating to involuntary deviate sexual intercourse) Section 3124.1 (relating to sexual assault) Section 3124.2 (relating to institutional sexual assault) Section 3125( relating to aggravated indecent assault) Section 3126 (relating to indecent assault) Section 3127 (relating to indecent exposure) Section 3129 (relating to sexual intercourse with animal) Section 4302 (relating to incest) Section 4303 (relating to concealing death of child)
(3) An offense SIMILAR IN NATURE to those crimes listed above in clauses (1) and (2) under the laws or former laws of: • the United States; or • one of its territories or possessions; or • another state; or • the District of Columbia; or • the Commonwealth of Puerto Rico; or • a foreign nation; or • under a former law of this Commonwealth.
A reportable offense enumerated under 24 P.S. §1-111(f.1) consists of any of the following: (1) An offense graded as a felony offense of the first, second or third degree, other than one of the offenses enumerated under 24 P.S. §1-111(e), if less than (10) ten years has elapsed from the date of expiration of the sentence for the offense. (2) An offense graded as a misdemeanor of the first degree, other than one of the offenses enumerated under 24 P.S. §1-111(e), if less than (5) five years has elapsed from the date of expiration of the sentence for the offense. (3) An offense under 75 Pa.C.S. § 3802(a), (b), (c) or (d)(relating to driving under influence of alcohol or controlled substance) graded as a misdemeanor of the first degree under 75 Pa.C.S. § 3803 (relating to grading), if the person has been previously convicted of such an offense and less than (3) three years has elapsed from the date of expiration of the sentence for the most recent offense.
PDE-6004 03/01/2016
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, 2018. 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 2017. 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 www.irs.gov/w4.
Personal Allowances Worksheet (Keep for your records.) A
Enter “1” for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . . A • You’re single and have only one job; or Enter “1” if: . . . B • You’re married, have only one job, and your spouse doesn’t work; or • Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less. 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 Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . . D Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above) . . E 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.) 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. G • 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. ▶ 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
}
{
B C D E F G
H
For accuracy, complete all worksheets that apply.
{
• If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions
and Adjustments Worksheet on page 2. • If you are single and have more than one job or are married and you and your spouse both work and the combined earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 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. Separate here and give Form W-4 to your employer. Keep the top part for your records.
Form
W-4
Department of the Treasury Internal Revenue Service
1
Employee’s Withholding Allowance Certificate
OMB No. 1545-0074
▶ 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.
Your first name and middle initial
2
Last name
Home address (number and street or rural route)
3
Single
Married
2017
Your social security number
Married, but withhold at higher Single rate.
Note: If married, but legally separated, or spouse is a nonresident alien, check the “Single” box. City or town, state, and ZIP code
4 If your last name differs from that shown on your social security card, check here. You must call 1-800-772-1213 for a replacement card. ▶
5 6 7
Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 5 Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . . 6 $ 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 . . . . . . . . . . . . . . . ▶ 7
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.) 8
Date ▶
▶
Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.)
For Privacy Act and Paperwork Reduction Act Notice, see page 2.
9 Office code (optional)
Cat. No. 10220Q
10
Employer identification number (EIN) Form W-4 (2017)
Page 2
Form W-4 (2017)
Deductions and Adjustments Worksheet Note: Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income. Enter an estimate of your 2017 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state 1 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 . . . . . . . . . . . . . . . . . . . . . $12,700 if married filing jointly or qualifying widow(er) 2 Enter: $9,350 if head of household . . . . . . . . . . . $6,350 if single or married filing separately 3 Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . 4 Enter an estimate of your 2017 adjustments to income and any additional standard deduction (see Pub. 505) Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to 5 Withholding Allowances for 2017 Form W-4 worksheet in Pub. 505.) . . . . . . . . . . . .
{
6 7 8 9 10
}
Enter an estimate of your 2017 nonwage income (such as dividends or interest) . . . . . . . . Subtract line 6 from line 5. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . 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 1 . . . . . . . . . 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
1
$
2
$
3 4
$ $
5 6 7 8 9
$ $ $
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. 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 “3” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
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 . . . . . . . . .
1
2 3
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 5 6 7 8 9
Enter the number from line 2 of this worksheet . . . . . . . . . . 4 Enter the number from line 1 of this worksheet . . . . . . . . . . 5 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . . Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . . Divide line 8 by the number of pay periods remaining in 2017. 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 2017. Enter the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck
Table 1 Married Filing Jointly
6 7 8
$ $
9
$
Table 2 All Others
Married Filing Jointly
If wages from LOWEST paying job are—
Enter on line 2 above
If wages from LOWEST paying job are—
Enter on line 2 above
$0 - $7,000 7,001 - 14,000 14,001 - 22,000 22,001 - 27,000 27,001 - 35,000 35,001 - 44,000 44,001 - 55,000 55,001 - 65,000 65,001 - 75,000 75,001 - 80,000 80,001 - 95,000 95,001 - 115,000 115,001 - 130,000 130,001 - 140,000 140,001 - 150,000 150,001 and over
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
$0 - $8,000 8,001 - 16,000 16,001 - 26,000 26,001 - 34,000 34,001 - 44,000 44,001 - 70,000 70,001 - 85,000 85,001 - 110,000 110,001 - 125,000 125,001 - 140,000 140,001 and over
0 1 2 3 4 5 6 7 8 9 10
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.
If wages from HIGHEST paying job are— $0 - $75,000 75,001 - 135,000 135,001 - 205,000 205,001 - 360,000 360,001 - 405,000 405,001 and over
Enter on line 7 above $610 1,010 1,130 1,340 1,420 1,600
All Others If wages from HIGHEST paying job are— $0 - $38,000 38,001 - 85,000 85,001 - 185,000 185,001 - 400,000 400,001 and over
Enter on line 7 above $610 1,010 1,130 1,340 1,600
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 6103. 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.
DCED-CLGS-06 (1-11)
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT GOVERNOR’S CENTER FOR LOCAL GOVERMENT SERVICES
LOCAL EARNED INCOME TAX RESIDENCY CERTIFICATION FORM TO E M P L O Y E R S / TA X PAY E R S : This form is to be used by employers and/or taxpayers to report essential information for the collection and distribution of Local Earned Income Taxes. This form must be utilized by employers when a new employee is hired or when a current employee notifies employer of a name and/or address change.
EMPLOYEE INFORMATION - RESIDENCE LOCATION NAME (Last, FIrst, Middle Initial)
SOCIAL SECURITY NUMBER
FIRST LINE OF ADDRESS (If PO Box, please include actual street address)
SECOND LINE OF ADDRESS
CITY
STATE
ZIP CODE
DAYTIME PHONE NUMBER
MUNICIPALITY (City, Borough, Township)
COUNTY
PSD CODE
TOTAL RESIDENT EIT RATE
EMPLOYER INFORMATION - EMPLOYMENT LOCATION EMPLOYER NAME (Use Federal ID Name)
EMPLOYER FEIN
Pennridge School District
23-1667853
FIRST LINE OF ADDRESS (IIf PO Box, please include actual street address)
1200 N. 5th Street SECOND LINE OF ADDRESS
CITY
STATE
ZIP CODE
PHONE NUMBER
Perkasie
PA
18944
215-257-5011
MUNICIPALITY (City, Borough, Township)
East Rock Hill Township COUNTY
PSD CODE
Bucks
0
9
MUNICIPAL NON-RESIDENT EIT RATE
1
1
0
3
1.00
CERTIFICATION SIGNATURE OF EMPLOYEE
PHONE NUMBER
DATE
EMAIL ADDRESS
For information on obtaining the appropriate MUNICIPALITY (City, Borough, Township), PSD CODES and EIT (Earned Income Tax) RATES, please refer to the Pennsylvania Department of Community & Economic Development website:
www.newPA.com Select Get Local Gov Support, >Municipal Statistics
Optional PENNRIDGE SCHOOL DISTRICT AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS (ACH CREDITS) REGULAR PAYCHECKS
I hereby authorize Pennridge School District, hereinafter called District, to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries in error to my checking/savings account as indicated below and the depository named below, hereinafter called DEPOSITORY, to credit and /or debit the same account. This authority is to remain in full force and effect until the District has received written notification from me of its termination in such time and in such manner as to afford the District and Depository a reasonable opportunity to act on it Please be aware that the first check issued by the District will be live while the bank confirms all routing and account numbers. Once confirmed your direct deposits will begin.
Original Voided Check / Savings Deposit Slip or direct deposit documentation from your financial institute must be attached Bank Name
ABA/Routing #
Account Type (circle one) checking / savings
Account Number
Amount or Net
checking / savings checking / savings checking / savings checking / savings
Employee Number _____________ Employee Name ___________________________________ (Print) Date _______________
Modified 12/09/2009
Signed ______________________________________
PENNRIDGE SCHOOL DISTRICT DISTRICT ADMINISTRATION OFFICE 1200 North Fifth Street ● Perkasie, Pennsylvania 18944
Prior School Employment TO:
Pennridge District Staff
FROM:
Jacqueline M. McHale, Director of Human Resources
RE: Prior School Employment Act 29 of 1994 changes the way the Commonwealth reimburses school entities for payments made to PSERS and social security. To comply with this law we must classify staff according to the following categories: 1. New Employee – an individual hired by the Pennridge School District after June 30, 1994, and not previously employed by a Pennsylvania public school district, intermediate unit or area vocational technical school. 2. Existing Employee – an individual hired by the Pennridge School District before July 1, 1994, OR and individual hired after June 30, 1994, but who was previously employed by a Pennsylvania public school, intermediate unite or area vocational technical school. Example: If you were employed as a Substitute Teacher years ago, but hired after June 30, 1994, Pennridge School District would consider you an existing employee.
Because our personnel records may not contain your entire employment history, we are asking you to designate your status by checking the appropriate category in accordance with the above definitions:
New Employee
Name:
Existing Employee
School:
Date:
It is important that you make an accurate designation and return this memo to the Human Resources Department so we can properly maintain your retirement account. Please note, this act has no effect on employees. Thank you for your cooperation. Mission Statement It is paramount that our students graduate with knowledge of their talents, passions and what is necessary for them to remain life-long learners and productive citizens. These objectives need to be accomplished in a community-oriented environment that is safe, welcoming, nurturing, student-centered and respectful of all. As such, the mission of the Pennridge School District is as follows: Pennridge School District strives to provide all students with a well-rounded educational experience where they acquire the 21st century skills necessary for a successful future. www.pennridge.org
PENNRIDGE SCHOOL DISTRICT 2017/2018 Pay Schedule Check Date 7/14/2017 7/28/2017 8/11/2017
Pay Period 6/26/2017 thru 7/9/2017 7/10/2017 thru 7/23/2017 7/24/2017 thru 8/6/2017
8/25/2017 9/8/2017 9/22/2017 10/6/2017 10/20/2017 11/3/2017 11/17/2017 12/1/2017 12/15/2017 12/29/2017 1/12/2018 1/26/2018 2/9/2018 2/23/2018 3/9/2018 3/23/2018 4/6/2018 4/20/2018 5/4/2018 5/18/2018 6/1/2018
8/7/2017 8/21/2017 9/4/2017 9/18/2017 10/2/2017 10/16/2017 10/30/2017 11/13/2017 11/27/2017 12/11/2017 12/25/2017 1/8/2018 1/22/2018 2/5/2018 2/19/2018 3/5/2018 3/19/2018 4/2/2018 4/16/2018 4/30/2018 5/14/2018
thru thru thru thru thru thru thru thru thru thru thru thru thru thru thru thru thru thru thru thru thru
6/15/2018 6/29/2018 7/13/2018 7/27/2018 8/10/2018
5/28/2018 6/11/2018 6/25/2018 7/9/2018 7/23/2018
thru thru thru thru thru
Start 22/26 TEA Pay Start 22 pay deductions
8/20/2017 9/3/2017 9/17/2017 Start 20 pay deductions 10/1/2017 10/15/2017 10/29/2017 11/12/2017 11/26/2017 12/10/2017 12/24/2017 1/7/2018 1/21/2018 2/4/2018 2/18/2018 3/4/2018 3/18/2018 4/1/2018 4/15/2018 4/29/2018 5/13/2018 5/27/2018 End 22 TEA Pay 6/10/2018 End 20 pay Deductions 6/24/2018 7/8/2018 7/22/2018 8/5/2018 End 26 TEA Pay
PENNRIDGE SCHOOL DISTRICT DISTRICT ADMINISTRATION OFFICE 1200 North Fifth Street ● Perkasie, Pennsylvania 18944
Jacqueline McHale, Director of Human Resources TO:
Source 4 Teachers/SAMS/AESOP Users
From:
Jacqueline McHale, Director of Human Resources
RE:
Attendance & Substitute Service
It is the philosophy of the Administration and the Board that the interests of our students are best served when our regular staff members are in attendance. As a professional educator or support personnel, it is expected that the employee demonstrate consistent attendance with the exception of illness, accidental injury, personal leave, and/or bereavement leave. As such, there are guidelines and procedures in place to assist the employee when requesting such leave. Reporting Absences: 1. Whenever it becomes necessary for you to be absent from your job, it is essential that you report your absence to SAMS/AESOP (Automated Educational Substitute OPerator), the automated substitute service. This includes positions that do not require a substitute. Based upon specific building procedures, you may also be required to contact the building principal and/or his/her designee. 2. The District utilizes Soarce4Teachers to provide substitute employees and to track accruals. Source4teachers provides the SAMS/AESOP system for absence reporting. The name of their system is simply SAMS. 3. You have access to SAMS twenty‐four hours per day, seven days per week. With the exception of an emergency, to ensure proper coverage, middle and high school staff should make every effort to report same day absences no later than 6:00 AM and elementary staff should report same day absences no later than 7:15 AM. How do I use AESOP to request an absence?
1. You may interact with the system through the internet at: http://www.source4teachers.com/SAMS 2. OR by calling the toll free number: 1‐800‐94‐AESOP (800‐942‐3767). 3. Enter your identification (ID) and PIN numbers. a. ID Number = your preferred phone number (followed by the # key – phone only). b. PIN Number = assigned by Source4Teachers (followed by the # key – phone only). Source4Teachers will provide a Welcome Letter, emailed to your district email, with your ID and PIN. Once an initial log‐in is performed, the PIN can be changed to any 4 or 5 digit number desired (easily remembered please) 4. Uploading Lesson Plans: Teachers are able to upload absence specific lesson plans or any informational document that could always be attached to any absences registered.
5. A SAMS Quick Start Guide/Tutorial for Employees is available on the website. It summarizes information relative to reporting absences, either by telephone or the internet. This system will enable you to enter absences, check your absence schedule, update personal information, and exercise other features. When entering an absence, please wait until you receive a confirmation number before you terminate the session. 6.
If you have any questions, please contact Source4Teachers at 856‐482‐0300 or by email at
[email protected].
In the case of an emergency (after 6:00 AM for middle/high school or after 7:15 AM for elementary): 1. High school staff members should report an absence via SAMS until the start of the work day. After the start of the work day call Source4Teachers at 856‐482‐0300 and also contact Mrs. Brenda Roth in the High School at 215‐453‐6944 Ext. 4119 if additional assistance is required. 2. Middle school staff members should report an absence via SAMS until scheduled building arrival time. If an emergency arises after the scheduled building arrival time, the building secretary should be contacted. 3. Elementary school staff members should report an absence via SAMS until scheduled building arrival time. If an emergency arises after the scheduled building arrival time, the building secretary should be contacted. 4. You can always call the call center at 856‐482‐0300 for unforeseen circumstances. 5. Human Resources is also available to assist with "unforeseen" issues between the hours of 8:00 A.M. and 4:00 P.M. daily at 215‐453‐2711. District Attendance Policy/Information 1. Sick Leave ‐ SAMS will allow an employee to enter short term "sick" absences (for up to 5 days) without pre‐approval. 2. Short term absences for personal leave and/or bereavement leave may be requested by entering the appropriate information into SAMS. SAMS will then initiate a request for approval from the building principal/supervisor. Upon approval/disapproval, SAMS will post the response from the building administrator on your SAMS web page. No other "paperwork" is necessary. 3. All employees should give adequate notice (refer to your Collective Bargaining Agreement) before a day of personal leave is taken by requesting the leave via SAMS. Exceptions will include emergency situations. 4. Vacation leave/Floating Holiday leave/Undesignated Holiday leave (for eligible 12 month employees) may be requested by entering the appropriate information into SAMS. SAMS will then initiate a request for approval from the building principal/supervisor. Upon approval/disapproval, SAMS will post the response from the building administrator on your SAMS web page. No other "paperwork" is necessary. 5. Conference Leaves MUST be pre‐approved by following the traditional paper method. Once approval on the "blue" conference form has been returned, the employee should then enter the absence into SAMS. 6. Leaves for Field Trips, Jury Duty, and Union Business may also be requested by entering the appropriate information into SAMS. SAMS will initiate a request for approval from the building principal/supervisor via email. Upon approval/disapproval, SAMS will post the response from the building administrator on your SAMS web page. No other "paperwork" is necessary. A minimum notice of one week should be given for all scheduled field trips, meetings and/or other activities. 7. All extended leaves (sick, personal, unpaid, bereavement, etc.) must be pre‐approved using the district approved forms and/or process.
8. An employee requiring the use of sick leave for a period of five (5) or more consecutive work days must also notify the District (in advance if possible) by completing a "Application for Leave of Absence" form, prior to said leave as well as a "Certification of Health Care Provider" form in advance for any pre‐ scheduled procedures or immediately upon return for any other unexpected absences. These forms will be available on the employee portal. No leave will be approved until such time as the appropriate documentation is submitted. Additionally, it is required that a doctor's note be submitted to release an employee to return to work after any scheduled surgery or leave beyond five (5) consecutive work days. 9. Any employee who is absent due to an on‐going intermittent and/or chronic condition and who is under a doctor's care must notify the District as soon as possible. 10. The District reserves the right to request verifiable absence information for absences less than (5) work days as deemed necessary. 11. It is the responsibility of the employee to monitor the use of sick and/or personal leave. Further, it is the responsibility of each employee to VERIFY time taken by reviewing their SAMS web page and pay stub on a regular basis. Errors or discrepancies should be immediately reported to the employee's supervisor using the “Accruals Correction Form” located on the employee portal. Since the pay period end dates are up to 2 weeks in arrears, balances will differ between SAMS (current to date and future) and the balance on the pay stub/voucher, which come from KRONOS, the District’s timekeeping system. 12. There will be NO leave without pay unless such leave is approved in advance by the Superintendent of Schools. If there are circumstances that do not allow prior notice, the employee must contact the Director of Human Resources, as the Superintendent's designee, to discuss the issue so that a decision may be made as to whether such circumstances justify an exception. *** Please refer to the appropriate Collective Bargaining Agreement for more specific information regarding employee leaves. *** Thank you for your cooperation with these matters. Please feel free to contact me if you have any further questions or concerns.
Mission Statement It is paramount that our students graduate with knowledge of their talents, passions and what is necessary for them to remain life-long learners and productive citizens. These objectives need to be accomplished in a community-oriented environment that is safe, welcoming, nurturing, student-centered and respectful of all. As such, the mission of the Pennridge School District is as follows: Pennridge School District strives to provide all students with a well-rounded educational experience where they acquire the 21st century skills necessary for a successful future. www.pennridge.org
PENNRIDGE SCHOOL DISTRICT Jacqueline McHale, Director of Human Resources DISTRICT ADMINISTRATION OFFICE 1200 North Fifth Street ● Perkasie, Pennsylvania 18944
****Attention New Employees:**** How do I register with SAMS? 1. Once Source4Teachers (SAMS) receives your new employee profile information, an email will be sent to your District email account with your ID and PIN. Please check your junk mail folder if you haven’t received this important information within a few days. 2. Call 1‐800‐942‐3767. 3. Enter your identification (ID) and PIN numbers. 4. Once logged on to the system, prompts will be given for the various menu choices. When initially accessing the SAMS system, it is very important that the name and assignment be recorded. Only the name and assignment should be recorded (e.g. John Doe, 3rd Grade) as SAMS will play this recording to potential substitutes for all future absences. No additional requests will be made to record this specific information 5. Remember to register with SAMS as soon as possible
Mission Statement It is paramount that our students graduate with knowledge of their talents, passions and what is necessary for them to remain life-long learners and productive citizens. These objectives need to be accomplished in a community-oriented environment that is safe, welcoming, nurturing, student-centered and respectful of all. As such, the mission of the Pennridge School District is as follows: Pennridge School District strives to provide all students with a well-rounded educational experience where they acquire the 21st century skills necessary for a successful future. www.pennridge.org
PSERS Communications
When you become a new member of PSERS, PSERS will mail you a Welcome Packet. The Welcome Packet will include reference to an Active Member Handbook, a Nomination of Beneficiaries (PSRS-187) form, and an Application for Multiple Service Membership (PSRS-1259). You may print the handbook from the PSERS website or call PSERS to request a copy of the handbook. If applicable, you will also receive a Class T-F Election Packet. If you are an active member of PSERS, you may be eligible to apply to purchase service credit. Certain types of service credit purchases have time restrictions. Please refer to your member handbook or PSERS website for additional details.
Naming a Beneficiary
After you are enrolled as a member of PSERS, you should designate a beneficiary(ies) to receive any benefits you have accrued if you die prior to retirement. You will receive a Nomination of Beneficiaries form (PSRS-187) with your Welcome Packet from PSERS. A new Nomination of Beneficiaries (PSRS-187) must be filed with PSERS anytime you change your beneficiary.
Multiple Service - 365 Day Election Deadline
If you have former service credited with the Pennsylvania State Employees’ Retirement System (SERS) for work performed for the Commonwealth of Pennsylvania (for example, Department of Public Welfare, Labor & Industry, Transportation, etc.), you may elect multiple service, which combines state and school service. You will receive an election form with the PSERS Welcome Packet. You have only 365 days from the date of your enrollment letter to make your multiple service election.
Keeping Your Address Current
Throughout the year, PSERS sends you important publications and notifications pertaining to your retirement account. For you to receive this information, you must keep your address current. You should notify your employer whenever your name and/or address changes.
Contacting PSERS
If you have any questions, please contact the PSERS Member Service Center by calling toll-free, 1.888.773.7748 (1.888. PSERS4U). Harrisburg local callers, please use 717.787.8540. The Member Service Center is staffed each business day from 8:00 a.m. to 5:00 p.m. To contact PSERS by email, use the following address:
[email protected]. For your convenience, PSERS also has eight regional field offices to serve you. For more general information or to find the regional office serving your area, you may visit PSERS online at www.psers.state.pa.us.
PSERS Information for New School Employees
5 N 5th Street Harrisburg PA 17101-1905 Phone: 888.773.7748 Website: www.psers.state.pa.us Email:
[email protected]
The information contained in this document is only for general reference. PSERS recommends that you review all documents that will be forthcoming from PSERS. The Public School Employees’ Retirement System (PSERS) provides this document for educational and informational purposes. Information in this document is general in nature, does not cover all factual circumstances and is not a complete statement of the law or administrative rules. The statements in this document are not binding. In any conflict between the statements in this document and applicable law or administrative rules, the law and administrative rules will prevail. This document is designed solely to provide an overview of benefits available to PSERS members and is not intended to be a substitute.
Welcome to the Public School Employees’ Retirement System Publication # 9800
1/2015
About PSERS... PSERS Membership
PSERS is a Defined Benefit retirement plan, which means your retirement benefit is determined by a defined formula. PSERS’ basic formula to calculate retirement benefits is based on a pension multiplier, your credited years of service, and your final average salary. All full-time employees must become members of PSERS and must make retirement contributions. “Full-time,” for retirement purposes, is defined as employees who work 5 or more hours a day, 5 days a week or its equivalent (25 or more hours a week), even if your employer considers you to be part-time. Part-time salaried employees qualify for PSERS membership as of their first day of employment and must have retirement contributions withheld. Part-time hourly and part-time per diem employees must meet minimum service requirements to qualify for PSERS membership (500 hours or 80 days). Once you meet membership requirements, subsequent service is qualified service unless there is a break in membership. Employers may opt to withhold retirement contributions for part-time hourly and per diem employees beginning with the first day of employment. Once you meet PSERS membership eligibility requirements, your employer must withhold PSERS retirement contributions. All part-time employees may waive membership in PSERS. To qualify for the waiver, the part-time employee must have an Individual Retirement Account and request a waiver within the first school year they qualify for PSERS membership. When you waive membership in PSERS, you forfeit all future rights to benefits for that waived school year. NOTE: If you are currently a PSERS retiree, your monthly benefit will stop upon re-employment unless you are hired under emergency or extracurricular employment (the provisions of Act 2004-63).
Membership Class of Service
The law governing PSERS sets the terms of membership classes. Your membership class is determined by the date you become a member of PSERS and the class election you make. For school employees who become new members of PSERS on or after July 1, 2011, there are two membership classes: Class T-E and Class T-F. New members automatically become Class T-E members, but have a one-time opportunity to elect Class T-F membership. PSERS will mail information and an election ballot to your home address. To elect Class T-F, you must return the ballot within 45 days of the date of notification. If you previously were a Class T-C or Class T-D member, and had a 90-day or longer break in service, in your new period of employment you will be a Class T-D member.
Benefit Eligibility upon Termination of Employment - Class T-E and Class T-F Benefit
Requirement
Refund of Contributions and Interest
Under age 65 with fewer than 10 years of service
Disability Retirement
5 years of service and medical eligibility
Vesting (deferring retirement)
10 or more years of service
Early Retirement
10 or more years of service at any age
Normal Retirement (Superannuation)
Age 65 with 3 years of service; or attain a total combination of age and service that is equal to or greater than 92 with a minimum of 35 years of service.
Employee Contribution Rate
Employee contribution rates are based on a member’s date of hire and class of service and are set by law. The contribution rate for Class T-E members is 7.50% (base) with “shared risk” provision that could cause the total contribution levels to fluctuate between 7.50% and 9.50%. The contribution rate for Class T-F members is 10.30% (base rate) with “shared risk” provision that could cause the total contribution levels to fluctuate between 10.30% and 12.30%. With a “shared risk” program, you benefit when investments of the fund perform well and share some of the risk when investments underperform. The employee contribution rate may not go below the base rate of 7.50% for Class T-E and 10.30% for Class T-F members. The contribution rate is set at 7.50% for Class T-D members enrolled on or after July 1, 2001. Contributions are not included as part of your gross income for federal tax purposes; they are federally tax-deferred.
Benefit Eligibility upon Termination of Employment - Class TD Benefit
Requirement
Refund of Contributions and Interest
Under age 62 with fewer than 5 years of service
Disability Retirement
5 years of service and medical eligibility
Vesting (deferring retirement)
5 or more years of service
Early Retirement
5 or more years of service at any age
Normal Retirement (Superannuation)
35 years of service at any age; age 60 with 30 years of service; or age 62 with 1 year of service.
