Form Depot

Human Resources & Payroll Forms (Form Depot)

The following is a list of forms required by the college human resources department. In most cases the forms can be downloaded and printed. Please do not submit forms to the college if you have not been directed to this site via the Three Rivers Community College human resources department.

General Forms

CT-W-4 Tax Withholding Form
Dual Employment Form (PER-DE-1)
Employment Application – Board of Trustees/Community Colleges
Employment/Examination Application PLD-1/State of CT
Employment Eligibility Verification (I-9)
Faculty: Evaluation & Overall Performance Form
Faculty: Instructional Observation Form for Classroom & ESL
Faculty: Instructional Observation Form for Clinical Settings
Faculty: Instructional Observation Form for Lab & Studio
Faculty: Self Appraisal Form
Federal W-4 Tax Withholding Form
FMLA – Employee Medical Certificate – 33A
FMLA – Care Giver Medical Certificate – 33B
FMLA HR1 – Employee Leave Request Form
FMLA HR3 – Employee Form – Intent to Return to Work (to be completed before the start of the leave)
FMLA HR2A – HR Employer Response Form – Notice of Eligibility and Rights and Responsibilities – revised May 2009
FMLA HR2B – HR Employer Response Form – Designation Notice
FMLA HR2c – HR Employer CORE Coding Form – revised May 2009
PER – 125: Performance Evaluation Form, Campus Police (NP-5 Union)
PER – 126: Service Rating Form, Admin and Clerical (NP-3 Union)
PER – 127: Service Rating Form, Admin and Residual (P-5 Union)
PER – 148: Service Rating Form, Maintenance and Service (NP-2 Union)
Placement on Statewide Transfer List Request Form
Request for Taxpayer Identification Number (Form W-9)

Workers Compensation Forms

Applications – Sabbatical FY23:

Applications – Promotion & Tenure: