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Payroll & Health Benefits


Commonly Used Forms:

Direct Deposit Form

Request for 12-Month Pay Option - CSEA

Federal Form W-4

State Form W-4

If you want your State and Federal withholding allowance to be the same only Federal Form W-4 is required.

If you want your State and Federal withholding allowance to be different both State and Federal Form W-4 is required.

Links for Retirement Information:

California State Teachers' Retirement System (CALSTRS)

California Public Employees' Retirement System (CALPERS)

TSA Consulting Group

Mid America (APPLE Plan)



The district uses several different time cards and it is important to submit your record of your time worked on the right time card. Please do not copy blank time cards to a different color card stock.

41025 CERTIFICATED (WHITE) To be used for certificated staff whose pay is not pro-rated monthly (hourly) to report all regular hours worked.  Also to be used for all certificated staff to report all hours worked in excess of contract schedule (overtime).

41027 CERTIFICATED SUBSTITUTE, ELEMENTARY (YELLOW) To be used for K-8 certificated substitutes.

41028 CERTIFICATED SUBSTITUTE, SECONDARY (GREEN) To be used for 9-12 certificated substitutes.

41029 CLASSIFIED PERMANENT HOURLY EMPLOYEES AND ADDITIONAL DUTY (BUFF) To be used for a permanent, classified employee whose salary is not pro-rated monthly, or for an employee who works additional hours beyond the normal schedule, but less than 8 hours in a day or 40 hours in a week.

41031 STUDENT, NOON SUPERVISOR, SUBSTITUTE AND TEMPORARY EMPLOYEES (PINK) (NOT CSEA MEMBERS) To be used for a non-CSEA classified employee who works less than 8 hours per day or less than 40 hours per week.

41033 CLASSIFIED COMMUNITY SERVICE (BLUE) To be used for a classified employee to report hours worked related to the use of district facilities or services by outside organizations such as Boy Scouts, churches, athletic leagues, etc.  Please note that there are two columns on this time card; one column is for “Regular Hours” worked and one column is for “Overtime” hours worked.  Please take care in listing hours worked in the appropriate column.

41034 CLASSIFIED EXCESS HOURS (PINK) To be used for those hours worked that exceed 8 hours per day, 40 hours per calendar week,  hours worked in excess of 5 consecutive days within the calendar week and hours worked on designated District holidays.


The sign in sheet is used in lieu of timecards by both certificated and classified employees whose salary is prorated on a monthly basis to document days and hours worked.

  1. Location and pay period must be designated.
  2. Employees should only make entries on the sign-in sheet for days they are at work.  The Principal or designee should post absence codes for all days an employee is not at work based on submitted leave requests.
  3. Principal or Site Administrator signature is required
  4. Sign-in sheet must be received in Payroll no later than seven (7) days after payday.
  5. For employees who do not work a five-day week, a slash mark should be marked in the cell representing for their scheduled days off.
  6. At month end, before submitting the sign-in sheet to Payroll, the Site Administrator should review the sign-in sheet to be sure that all approved leave requests have been noted with the appropriate alpha absence code (see chart on page 23).   Absence codes should be provided for each day of leave for whatever reason.

A blank space indicates that an employee who was scheduled to work did not work or submit a Request for Leave form which may result in an adjustment to the employee’s pay.

Health Benefits


Dental Enrollment Form - Certificated, Management & Confidential

Dental Enrollment Form - Classified - use until August 2017

Anthem Blue Cross Enrollment Form

Kaiser Enrollment Form

Vision Enrollment Form


Please review the information contained below on available health benefits.

Active Rates 2016-2017 - rates effective January 1, 2017 - December 31,2017 unless noted

Glossary of Health Coverage and Medical Terms

Health Care Reform

We would like to take this opportunity to describe and explain the improvements made to several of our group health plans as required under Health Care Reform. It is important that you review and share this communication with your family... Read More



BenefitBridge is a program for benefit eligible employees to use to find information about the dental, vision and /or medical plans that they are currently enrolled into or who is enrolled in their plan. Click here to access the BenefitBridge Website.  The website performs best in Google Chrome.

BenefitBridge Registration Instructions

Need help using BenefitBridge:
Call BenefitBridge Support at (800) 814-1862
Monday thru Friday 8:00 am – 5:00 pm (PST)
Or email



Kaiser Permanente

Plan Summaries:

2017 - Traditional Benefit Summary - 1/1/17 - 12/31/17 - no new enrollments as of April 2016.

2017 - Low Benefit Summary - 1/1/17 - 12/31/17

2017 - Deductible HMO Benefit Summary - 1/1/17 - 12/31/17

2017 - 2700 HSA Benefit Summary - 1/1/17 - 12/31/17

2017 Sample Fee List

2017 Specialty Drug List

    Contact Membership Services
    (800) 464-4000


    Anthem Blue Cross

    Plan Summaries:

    2017 - PPO $25 Benefit Summary

    2017 - PPO $60 Benefit Summary

    2017 - EPO $30 Benefit Summary



      Delta Dental


      Certificated, Management and Confidential Employees - Administered by CVUSD

      Delta Dental of California
      PO BOX 997330
      Sacramento, CA 95899-7330
      (866) 499-3001

      Plan Summaries:

      High Option - Required 3 year Commitment

      Mid Option - Employee Default

      Low Option


      Classified Employees - Administered by California's Valued Trust - until September 30, 2017

      Delta Dental of California
      PO BOX 997330
      Sacramento, CA 95899-7330
      (800) 765-6003

      Plan Summaries:

      Dental Plan Booklet

      Age 26 Fact Sheet

      Eligible Dependent Documentation Requirements

        There are no membership cards for Delta Dental. Give your provider the SSN and DOB of the enrollee receiving services.



        Vision Service Plan (VSP)

        Customer Service
        (800) 877-7195
        Monday thru Friday 5:00 am - 7:00 pm (PST)

        Plan Summaries:

        Buy Up Plan - 1/1/16 - 12/31/16

        Base Plan - 1/1/16 - 12/31/16

        Provider Choices

        Laser Discount Program

        Contact Lens Care Program Member Flyer

          There are no membership cards for VSP.  Give your provider the SSN and DOB of the enrollee receiving services.


          Business Services

          Assistant Superintendent of Business Services
          Dr. Candi Clark
          (510) 537-3000 ext. 1212

          Director of Business Services
          (510) 537-3000 ext. 1223




          Certificated Payroll
          (510) 537-3000 ext. 1233

          Classified Payroll

          (510) 537-3000 ext. 1239

          Position Control

          (510) 537-3000 ext. 1288

          Health Benefits

          Employee Benefits
          Robin H. Yearby
          (510) 537-3000 ext. 1231