Human Resources Department

Benefits (BEN)

BEN-F001	Authorization Agreement for ACH Debits
BEN-F002	Declination/Group Health Ins. Coverage
BEN-F004	Retirement Insurance Payment Sheet
BEN-F005	Request to Cancel Ins. Blue Cross Blue Shield (11/10/2011)
BEN-F006	Request to Delete Dependents Med & Dent. Pol. (5/15/2012)
BEN-F007	Check Request for Benefits Connection
BEN-F008	Negative Supplement (Refund)
BEN-F009	403(b) Termination Request (9/15/2011)
BEN-F010	Supplement (9/21/2006)
BEN-F011	Retirement (9/15/2011)
BEN-F012	Change in 403(B) Contribution (9/15/2011)
BEN-F013	Clarksville Mont Emp Ins Trust VSP Plan Enroll
BEN-F014	Request to Cancel/Change Insurance VSP (9/15/2011)
BEN-F015	LOA Payment Sheet (10/2/2008)
BEN-F026	Self Administered Life Insurance Enrollment Card
BEN-F027	Self Administered Life Ins. Change of Beneficiary
BEN-F029	Flexible Benefits Plan Section 125 Election From (9/15/2011)
BEN-F031	Results of Physical Examination
BEN-F032	Retirement Incentive Effective 9/1/2011 (8/6/2010)
BEN-F033	CMCSS Retiree Life Insurance Policy
BEN-F034	Certified Staff Benefits Processing Information Checklist
BEN-F034a	Classified Staff Benefits Processing Information Checklist
BEN-F035	Request to Cancel Dependent Care Spending Account (9/15/2011)
BEN-F036	Request to Cancel Flexible Spending Account (9/16/2011)
BEN-F038	$100,000 Non-Contributory Accidental Death & Dismemberment Change of Beneficiary
BEN-F039	Benefits Response Log
BEN-F040	Cobra Dental Election (7/21/2010)
BEN-F041	Certification of Dependency (10/28/2005)
BEN-F042	Supplemental Voluntary Life Insurance Cancellation Request (6/23/2008)
BEN-F043	$100,000 Non-Contributory Accidental Death and Dismemberment Enrollment (10/6/2006)
BEN-F044	Payroll Deduction Authorization re On-Site Healthcare (9/2/2011)
BEN-F045	DCAP Change June 2012 Payroll (4/30/2012)
BEN-F046	DCAP Change September 2012 Payroll (4/30/2012)
BEN-F047	Deposit for Payroll Deductions (8/2008)
BEN-F048	403(B) Tax-Sheltered Annuity Plan Acknowledgement and Opt-Out Form (6/26/2008)
BEN-F049	Retirement Information Checklist (11/10/2009)
BEN-G001	Notice of Privacy Practices (2/22/2012)
BEN-P001	Benefits Enrollment (11/22/2011)
BEN-P002	Benefits Termination (11/22/2011)
BEN-P003	Privacy Notice (2/22/2012)
BEN-P004	Employee Retirement (3/11/2009)
BEN-P005	Retiree Benefit Changes (2/8/2012)
BEN-P008	CMCE Insurance Trust Meeting (2/8/2012)
BEN-P016	Recording Deposit Transmittals for Checks From Employees, Retirees and Insurance Cos. (2/23/2012)
BEN-P017	Insurance Statement Reconciliation and Payment (2/23/2012)
BEN-P018	403(b) Enrollment and Payment (3/12/2012)
BEN-P021	Payments to Beneflex for MedFSA & DCAP Administrative Fees (2/23/2012)
BEN-P022	Payments for MedFSA/DCAP Account Claims (3/23/2012)
BEN-P023	Adverse Blue Cross Blue Shield Benefit Appeal Procedure (9/2/2011)
BEN-P024	Terminating Benefits of CMCSS Employees (3/16/2012)
BEN-P025	Retiree Payment of Monthly Premiums Procedure (3/12/2012)
BEN-W001	Documenting a Cash/Check/or Money Order Payment from a Retiree (12/15/2008)
BEN-W002	Requesting a Check for Payment to Beneflex for MFS Account (2/10/2009)
BEN-W003	Name Change for Blue Cross Blue Shield of TN (3/4/2010)
BEN-W004	Completing Retirement Paperwork (6/28/2010)

Certified Staff (CER)

CER-F001	Student Discount Form (12/11/2003)
CER-F002	CMCSS Rating System
CER-F003	Certified Professional Reference Request (4/24/2012)
CER-F004	Certified Application (6/26/2003)
CER-F005	CMCSS Certified Employment Questionnaire
CER-F006	Job Fair Registration
CER-F007	Salary Advancement Request
CER-F008	Certified Employee Checklist
CER-F009	Highly Qualified Status Page
CER-F010	In-Processing Acknowledgment Statement (11/9/2011)
CER-F011	Acceptance Letter (6/15/2009)
CER-F012	Request for Salary Credit Beyond the Master's Degree (4/17/2007)
CER-F012a	Request for Salary Credit Beyond the Bachelor's Degree (4/19/2007)
CER-F012b	Request for Change of Salary Lane (4/19/2007)
CER-F013	Supplemental Homebound
CER-F014	Personnel Record of Teacher or Principal
CER-F015	New Teacher Letter (4/23/2010)
CER-F016	Acceptance of Sick Leave (5/20/2008)
CER-F016a	Withdraw of Sick Leave (5/20/2008)
CER-F017	Intent to Hire (7/5/2007)
CER-F018	CMCSS Offer of Employment (10/19/2011)
CER-F019	ELL Applicant Language Screening Form (1/6/2012)
CER-F020	Contract for New Employee Sign-On Bonus(4/17/2012)
CER-G001	ELL English Fluency Rubric (1/12/2012)
CER-P001	Certified Staff Application (5/4/2012)
CER-P002	Student Discount Request Procedure(4/23/2012)
CER-P003	In-Service Hours Reporting (10/25/2010)
CER-P004	Hiring ELL Teachers Working with English Learners (1/12/2012)
CER-W003	In-Processing New Teachers (12/3/2008)

Classified Staff (CLS)

CLS-F003	CMCSS Evaluation Form For Classified Staff
CLS-F004	Classified Employment Reference Request (4/24/2012)
CLS-F006	Cafeteria Monitor, Admin Asst, & Office Asst Applicant Scoring
CLS-F007	Custodial, Maintenance, & Warehouse Applicant Scoring
CLS-F011	Educational Assistant Applicant Scoring
CLS-F012	ParaProfessional Study Guide
CLS-F013	Performance Evaluation: Cafeteria Assistant
CLS-F014	Performance Evaluation: Cafeteria Manager
CLS-F015	Classified Job Fair Registration Form (5/20/2005)
CLS-F016	Drivers' License Information
CLS-F017	Summer Salary Distribution Option (6/23/2008)
CLS-F018	Offer of Employment (Classified)
CLS-F019	Verification of Prior Job Experience (11/9/2011)
CLS-F019a	Classified New Hire Prior Experience/Education Request (11/9/2011)
CLS-F020	Maintenance/Transportation/Warehouse Performance Evaluation Form
CLS-F021	Cafeteria Monitor/Educational/Media Assistant/Nurses Performance Evaluation Form
CLS-F022	Classified Staff Grievance Form - please see HUM-F061
CLS-F025	In-Processing Acknowledgment Statement (4/13/2012)
CLS-F026	New Employee Correspondense re: Step Increase
CLS-F027	To Process Substitute Bus Aides (4/20/2012)
CLS-F028	To Process Substitute Bus Drivers (4/20/2012)
CLS-F030	Accepting Employment as Educational Assistants Memorandum
CLS-F032	To Process Substitute School Nurses (4/20/2012)
CLS-F033	Food Service Assistant Applicant Scoring
CLS-F034	School Nurse Performance Evaluation and Clinic Audit Form
CLS-F035	Accounting Associate & Bookkeeper Applicant Scoring
CLS-F036	School Nurse Applicant Scoring
CLS-F037	CMCSS Applicant Scoring System for Technology Positions (1/28/2010)
CLS-F038	Request for Sub Status(4/17/2012)
CLS-P001	Classified Staff Application (5/30/2007)
CLS-P002	Probationary Credit for TCRS (8/25/2008)
CLS-P003	ParaProfessional Testing (3/9/2007)
CLS-P004	Classified Staff Layoff and Recall (2/16/2011)
CLS-P006	Classified Staff Grievance (4/6/2006)
CLS-P007	Health Services Application Procedure (6/1/2011)
CLS-W001	Resignation/Retirement of Classified Employee Work Instruction (12/11/2008)
CLS-W002	Job Class Code for Classified Staff Work Instruction (12/11/2008)
CLS-W003	Recommendation for Employment for Transfer of Classified Staff (12/18/2008)
CLS-W004	Recommendation for Employment New Hire of Classified Staff (12/18/2008)

Health (HEA)

HEA-F006	Communicable Disease Notification (3/27/2012)
HEA-F007	Notice to Parents-Head Lice (3/23/2012)
HEA-F013	Medication Reminder (3/28/2012)
HEA-F015	Immunization and Physical Examination (2/7/2012)
HEA-F017	Nurse's Notes (4/6/2011)
HEA-F020	Health Services Mass Vision Screening Recording Form (4/6/2011)
HEA-F024	Health Services Student Medication Record (2/8/2011)
HEA-F028	Mass Hearing Screening Recording (4/6/2011)
HEA-F036	Asthma Individual Health Care Plan (4/6/2011)
HEA-F037	Clinic Referral (3/23/2012)
HEA-F038	Severe Allergy Individual Health Care Plan (4/6/2011)
HEA-F040	Parent/Guardian Notification (Medication, Minor Injury, Clinic Visit and Supplies) (3/23/2012)
HEA-F041	Parent/Guardian Notification of Illness/Condition (3/27/2012)
HEA-F042	Diabetes Individual Healthcare Plan (4/5/2012)
HEA-F044	Diabetes Record (4/5/2012)
HEA-F045	Physician's Orders for Feeding (4/6/2011)
HEA-F046	Mass Hearing and Vision Referrals (4/6/2011)
HEA-F047	Vision Refferal (4/6/2011)
HEA-F048	Parent/Guardian Input Feeding Tube Management (4/6/2011)
HEA-F049	Parent/Guardian Input Tracheostomy Management (4/6/2011)
HEA-F050	Hearing Referral Form (4/6/2011)
HEA-F051	Physician's Orders for Tracheostomy Care (4/6/2011)
HEA-F052	Authorization for Use or Disclosure of Health Information to and from School Districts (4/6/2011)
HEA-F059	Authorization and Contract for Self-Carry/Administration of Medicine at School (3/28/2012)
HEA-F062	Authorization for Medication to be Taken During School Hours (2/10/2011)
HEA-F063	Seizure Report Flow Sheet (4/5/2012)
HEA-F065	Consent for Flu Vaccine(5/1/2012)
HEA-F066	Tube Feeding Flow Sheet (4/6/2011)
HEA-F070	Physician's Order Form for Oxygen Administration (4/6/2011)
HEA-F072	Physician's Order Form for Machine Suctioning (4/6/2011)
HEA-F073	Suctioning Schedule (4/16/2012)
HEA-F074	Physician's Order Form for Catheterization (4/6/2011)
HEA-F076	Physician's Orders for Colostomy/Ileostomy Care (4/23/2012)
HEA-F077	Student Instruction Form Changing Colostomy/ Ileostomy Bag (4/6/2011)
HEA-F078	Seizure Individual Health Care Plan (2/10/2011)
HEA-F080	Medication Error Report (3/21/2012)
HEA-F081	Medication Count (3/23/2012)
HEA-F082	Consent for Vision and/or Hearing Screening (3/27/2012)
HEA-F083	Physician's Order for the Administration of Diastat in the School Setting (2/10/2011)
HEA-F084	Report of Administration of Diastat (2/10/2011)
HEA-F085	Invalid Emergency Phone Numbers (5/1/2012)
HEA-F086	Confidentiality Statement (2/7/2012)
HEA-F089	Medication Expiration Notice (3/21/2012)
HEA-F090	AED Incident Report (5/1/2012)
HEA-F091	Monthly AED Log (5/1/2012)
HEA-F092	Request for Exemptions from Immunizations (2/7/2012)
HEA-F093	Notification of Parent-Administered Medication Outside of School Hours (3/23/2012)
HEA-F094	Medication Administration Skills Checklist (9/29/2011)
HEA-F095	Notice to Parents - Bed Bugs (2/3/2012)
HEA-F096	Bed Bug Inspection Report (2/3/2012)
HEA-G001	Bed Bug Management (2/3/2012)
HEA-G002	Bed Bug Information (2/7/2012)
HEA-G003	Glucagon Medication Administration Guidelines (3/21/2012)
HEA-G004	Anti-Seizure Emergency Medication Administration Guidelines (3/21/2012)
HEA-G005	Head Lice Management (3/26/2012)
HEA-G006	Head Lice Information (3/26/2012)
HEA-G007	Epinephrine Administration Guidelines (3/26/2012)
HEA-G008	Guidelines for Dismissal or Exclusion From School (3/27/2012)
HEA-M001	Health Services Policy and Procedure Manual
HEA-P001	Communicable Diseases (3/27/2012)
HEA-P002	Medication Administration (3/28/2012)
HEA-P003	Emergency Anti-Seizure Medication Administration Procedure (2/10/2011)
HEA-P004	AED Response (5/1/2012)
HEA-P005	Insulin Administration Procedure (10/4/2011)
HEA-P006	Influenza Vaccine Administration Procedure (5/7/2012)

Human Resources (HUM)

HUM-F002	Notification of Vacancy (7/19/2007)
HUM-F003	Recommendation for Employment (6/15/2009)
HUM-F004	Request for Transfer - Certificated Personnel (8/30/2011)
HUM-F005	Request for Transfer - Classified Staff Personnel (9/13/2011)
HUM-F006	Contact Report (8/5/2004)
HUM-F007	Employee Record Card
HUM-F008	Classified Staff Check Off Sheet For Processing a New Employee (6/22/2011)
HUM-F009	Application Check List
HUM-F010	Custodian-Maintenance Criteria Sheet
HUM-F011	Instructional Personnel Criteria Sheet
HUM-F012	Comprehensive Assessment--Summative Report
HUM-F013	Comprehensive Assessment--Planning Information Record
HUM-F014	Development Plan
HUM-F015	Leave of Absence/Family Medical Leave Act (6/22/2011)
HUM-F016	CMCSS Request for Leave of Absence/FMLA (6/11/2009)
HUM-F017	Direct Deposit of Paychecks Statement
HUM-F020	Sick Leave Bank Enrollment Form (2/22/2007)
HUM-F021	Supplement List Form
HUM-F022	Request for Vacation
HUM-F023	Sick Leave Report
HUM-F024	Personal Leave (2/12/2004)
HUM-F025	Request for Days re Sick Leave Bank (11/24/2009)
HUM-F026	Medical Certification Form re Sick Leave Bank (12/18/2006)
HUM-F028	Title VI and Other Discrimination Complaint Form (8/27/2010)
HUM-F029	Technology Competency-Summative Report
HUM-F030	Resignation (7/17/2007)
HUM-F031	Extension for LOA/FMLA (3/4/2005)
HUM-F032	Vacancy
HUM-F033	Disposition of Unused Personal Leave (4/23/2012)
HUM-F034a	Fingerprint Form (10/7/2011)
HUM-F034b	Bus Driver Applicants Finger Print Form (4/9/2008)
HUM-F036	Sexual Harassment Report (7/14/2005)
HUM-F037	Report of Investigation of Sexual Harassment Complaint by Student (7/14/2005)
HUM-F038	Report of Investigation of Sexual Harassment Complaint by Employee (2/8/2008)
HUM-F041	Employee Training Verification Sheet (7/19/2011)
HUM-F042	Job Description Template
HUM-F042a	Administrative Employees Job Description Template
HUM-F043a	Results of Physical Examination for Pre-School Teachers & Ed. Assistants (9/2/2011)
HUM-F044	CMCSS Elementary Staffing (8/23/2006)
HUM-F045	CMCSS Middle School Staffing (5/10/2006)
HUM-F046	CMCSS High School Staffing (5/10/2006)
HUM-F047	Personal Data Form (4/23/2010)
HUM-F048	No longer available; please use HUM-F050
HUM-F050	Department of Children Services Referral (3/1/2012)
HUM-F051	Preschool Education Assistant (12/19/2007)
HUM-F052	Condition of Employment/Custodial Operations (1/22/2007)
HUM-F053	Corrective Plan (10/20/2009)
HUM-F054	Corrective Plan Update (6/14/2007)
HUM-F055	DCS Checkoff Sheet (7/5/2007)
HUM-F057	Contract for Testing, Training and Tuition Reimbursement (9/2/2011)
HUM-F058	Application for Employment: Supplemental Coaching (2/10/2011)
HUM-F059	Reporting "Off the Clock" Work Acknowledgement Form (11/9/2009)
HUM-F060	Employee Health Certification (1/12/2010)
HUM-F061	Employee Grievance Form (4/2/2012)
HUM-G001	Training Guidelines for Reporting Suspected Child Abuse and Accomodating DCS Investigations (6/2/2011)
HUM-G002	Training Guidelines for Recognizing Sexual Harassment (7/10/2009)
HUM-G003	Guidlines for Telephonic Employment Reference Checks (7/16/2009)
HUM-G004	Maternity Leave Guide (5/18/2009)
HUM-M001	Employee Handbook (3/12/2012)
HUM-P001	Creation of  Employee Record (8/7/2006)
HUM-P002	Hiring (4/12/2007)
HUM-P003	New Hire In-Processing (4/6/2010)
HUM-P004	Name Change (6/25/2009)
HUM-P005	Job Vacancy Posting (11/6/2003)
HUM-P006	Leave of Absence Request (9/3/2008)
HUM-P008	Supplements (3/5/2007)
HUM-P009	Out Processing a Permanent Employee (3/5/2007)
HUM-P010	Title VI and Other Discrimination Complaints (12/15/2009)
HUM-P011	Sick Leave Bank Enrollment (7/16/2007)
HUM-P012	Request for Days from the Sick Leave Bank (7/17/2007)
HUM-P013	Hiring Administrators and Supervisors (1/19/2007)
HUM-P014	Reporting Suspected Child Abuse (6/1/2011)
HUM-P015	Accommodating DCS Investigations (7/15/2008)
HUM-P016	Background Verification (12/3/2008)
HUM-P016a	Bus Driver Applicants Background Verification (2/19/2009)
HUM-P017	Employment Verification By Mail (9/3/2008)
HUM-P018	Employment Verification By Telephone (2/16/2007)
HUM-P019	Reporting Allegations of Sexual Harassment (7/21/2008)
HUM-P021	Certified Voluntary Transfer Procedure (11/1/2011)
HUM-P022	Employee Grievance Procedure (11/7/2011)
HUM-P023	Local Evaluation Grievance of Teacher or Principal (11/22/2011)
HUM-W001	Tennessee New Hire Reporting (3/28/2007)
HUM-W002	Verification of Employment (11/19/2008)
HUM-W003	Leave of Absence Work Instructions (11/19/2008)
HUM-W004	Unemployment Separation Form Work Instruction (1/28/2009)
HUM-W005	Request for Placement of a Student Teacher, Intern, or Observation Candidate Work Instruction (9/2/2011)
HUM-W006	Making an Employee ID Badge (3/4/2010)
HUM-W007	Fingerprints for New Employees (3/4/2010)
HUM-W008	Staff Name Change (6/28/2010)

On The Job Injury (OJI)

OJI-F001	Claimant Survery
OJI-F002	OJI Program Acknowledgement Form (9/13/2011)
OJI-F003	Employee Injury Statement (6/23/2011)
OJI-F005	OJI Log (3/3/2011)
OJI-F006	OJI Claim Data (OJI Office Use Only)
OJI-F007	Risk Management/Safety Department Claim Notes (3/3/2011)
OJI-P001	On The Job Injury (2/20/2012)
OJI-PRO1	OJI Program (6/23/2011)

Professional Development (PRD)

PRD-F001	Plan Course Creation Template (5/27/2010)
PRD-F004	Professional Development Planning Resources Request Form (4/24/2006)
PRD-F005	Request for In-Service Approval (6/9/2008)
PRD-F006	CMCSS Attendance Record (7/1/2010)
PRD-F008	Custodial Training Record Level I (effective March 1, 2007)
PRD-F008a	Custodial Training Record, Level II (effective March 1, 2007)
PRD-F012	Request for Approval of Professional Learning Project (6/30/2008)
PRD-F013	Mentors for Apprentice Teachers (7/22/2009)
PRD-F014	Contractor/Consultant Invoice (10/18/2010)
PRD-F015	Classroom Instruction That Works Program Receipt
PRD-G001	Professional Development PLAN Keywords for Course Development Guide (12/1/2010)
PRD-P001	In-Service Requirements (2/22/2012)
PRD-P002	Custodial Training Procedure (effective March 1, 2007) (1/22/2007)
PRD-P003	In-Service Cancellation Past Withdrawal Deadline Procedure (10/5/2011)

Risk Management (RSK)

RSK-F003	Confined Space Entry Permit (4/15/2011)
RSK-F004	Electrical Inspection Checklist (4/15/2011)
RSK-F005	Ladder Inspection Checklist (4/15/2011)
RSK-F006	Excavation Checklist (4/15/2011)
RSK-F007	Recommended Roof Work Safety Checklist (4/15/2011)
RSK-F008	Hot Work Permit (12/6/2010)
RSK-F011	Mandatory New Employee Safety Training
RSK-P001	Property Loss Claim (4/6/2011)
RSK-PRO1	Bloodborne Pathogens Exposure Control (7/28/2010)
RSK-PRO2	Confined Space (7/28/2010)
RSK-PRO3	Electrical Safety and Related Work Practices (7/28/2010)
RSK-PRO4	Ladder Safety (4/15/2011)
RSK-PRO5	Trenching and Excavation (7/28/2010)
RSK-PRO6	Personal Protective Equipment (7/28/2010)
RSK-PRO7	Contractor Safety (7/28/2010)
RSK-PRO8	Hand Safety Tools (7/28/2010)
RSK-PRO9	Hazard Communication (7/28/2010)
RSK-PRO10	Hearing Conservation (5/12/2011)
RSK-PRO11	Machine Guarding (7/28/2010)
RSK-PRO12	Compressed Gas Safety (7/28/2010)
RSK-PRO13	Fall Prevention/Fall Protection (7/28/2010)
RSK-PRO14	Lockout/Tagout/Verification (7/28/2010)
RSK-PRO15	Fire Prevention (7/28/2010)
RSK-PRO16	Heat Stress Protection (7/28/2010)
RSK-PRO17	Employee Rights and Responsibilities (7/28/2010)
RSK-PRO18	Supervisor Responsibilities (7/28/2010)
RSK-PRO19	Health and Safety Complaint (7/28/2010)
RSK-PRO20	Departmental Safety (7/28/2010)
RSK-PRO21	Hot Work Safety (12/6/2010)

Safety (SAF)

SAF-F001	Student Accident Report Form (4/6/2011)
SAF-F002	Monthly Fire Drill Report (7/13/2011)
SAF-F003	CMCSS Monthly Playground Inspection Checklist (4/15/2011)
SAF-F004	Hepatitis B Vaccine Declination Form (4/15/2011)
SAF-F005	Bomb Threat Checklist (5/12/2011)
SAF-F006	Blood Borne Pathogen Exposure (4/6/2011)
SAF-F007	Emergency Areas (5/12/2011)
SAF-F008	Emergency Shut-Off Locations for Utilities/HVAC (5/12/2011)
SAF-F009	Field Trip Emergency Management Procedures Checklist (6/16/2009)
SAF-F010	Field Trip Emergency Numbers (5/12/2011)
SAF-F011	First Aid/CPR/AED Trained Personnel (5/12/2011)
SAF-F012	Hazardous Chemical Storage Locations (5/12/2011)
SAF-F013	Incident Log Form (5/12/2011)
SAF-F014	Memorandum of Understanding (5/12/2011)
SAF-F015	Post-Incident Critique (5/12/2011)
SAF-F016	Reunification Release Form (5/12/2011)
SAF-F017	School After Hours Contact Information (5/12/2011)
SAF-F018	School Demographics (5/12/2011)
SAF-F019	School Emergency Management Team Contact Information (5/12/2011)
SAF-F020	Special Needs Procedures Summary Sheet (5/12/2011)
SAF-G001	School Emergency Management Team Information (9/13/2011)
SAF-P001	Student Accident Reporting (4/6/2011)
SAF-P003	Environmental & Health Complaints (4/6/2011)
SAF-P004	Blood Borne Pathogens (4/6/2011)

Substitutes (SUB)

SUB-F003	Classification Code List-Food Service & Nurses
SUB-F004	Substitute Employee Profile