LOS RIOS COMMUNITY COLLEGE DISTRICT
ARC
CRC
DO
Location
EDC
Ethan
FLC
Employee ID
FM
SCC
Other
EMPLOYMENT SERVICE
AGREEMENT (ESA) #:
__________
Last Name
__
First Name / Middle Initial
Home Address
Home Telephone
Business Telephone
City and State
Zip Code
SSN (Only if Employee ID is not available)
CHECK ONE:
NOT FOR-CREDIT CLASSES
Date(s) Services Rendered: Beginning Date:
CONTRACT CLASSES
SPECIAL SERVICES
Ext.
PROFESSIONAL EXPERT
Ending Date:
ESA must be for fiscal year only. Any portion that crosses the fiscal year must be submitted on a separate ESA.
Either party may terminate this agreement at any time, with or without cause, effective immediately upon notifying the other party in writing of
the contract termination. Compensation due employee shall be prorated. This agreement contains the Entire Agreement and understanding
between the parties. There are no oral understandings, terms or conditions, and neither party has relied upon any representation, express or
implied, not contained in this agreement.
Description of Services to be Rendered (if additional description space is needed, please submit as an attachment):
#1.) Is this ESA for Instructional work (i.e. check “no” if the instructional work is for not-for-credit courses)?
No /
Yes
If no to #1, are minimum qualifications required?
No /
Yes
#2.) Is this ESA STRS Creditable?
No /
Yes (for additional information, go to: http://www.losrios.edu/hr/ESA%20Page/step3.htm)
#3.) Ask the employee the following with each ESA: Are you currently a member of the California Public Employee’s Retirement System (CalPERS) or
State Teachers’ Retirement System (CalSTRS)?
No /
Yes If Yes, answer:
PERS /
STRS
AND
Active /
Retired
Note: Please make sure the employee is given a SSA -1945 form and a PARS packet for all 1st ESA assignments with Los Rios CCD.
Are these duties creditable toward the 67% law – PLEASE NOTE: ALL ESAs for FT Faculty Members are subject to the 67% lawl
Yes (Core full-time faculty duties such as curriculum development, class preparation and grading.)
No (Duties such as governance, staff development, grant writing, advising student organizations, special projects, etc.)
POSITION # _
_
BUDGET # __
_/_
_ / __
____ / __
__ / _
_ / __
___
POSITION # _
_
BUDGET # __
_/_
_/ ___
___ / ___
_/_
_ / ___
___
Account
Fund
Org/GL Dept. ID
Program
Proj/Grant
Distribution Amount
Account
Fund
Org/GL Dept. ID
Program
Proj/Grant
Distribution Amount
IT IS UNDERSTOOD THAT UNLESS THERE IS SUFFICIENT ENROLLMENT OR WORKLOAD TO MEET BUDGETED EXPENSE, THIS ACTIVITY WILL BE CANCELLED.
Specific Terms of Compensation - check appropriate payment type: Payment is in hours
; days
Rate per Hour/Day $ _
__ Total Number of Hours/Days: Fall_
_ Spring_
Summer_
_
Total Cost $ _
_____
Rate per Hour/Day $ _
__ Total Number of Hours/Days: Fall_
_ Spring_
Summer_
_
Total Cost $ _
_____
W-4 Form
Demographic Form
I-9 Form
TB Test Clearance
Copy of Social Security Card (for IRS purposes)
Compliance Checklist
*SSA-1945 (Submit with the 1st ESA issued to employee)
*PARS Packet (Submit with the 1st ESA issued to employee)
; or, lump sum payment
Fingerprint Process Completed
Fingerprint Deduction Form
(Attach Livescan 2nd copy)
Employment Eligibility Disclosure Form and if applicable, P-881
All Appropriate Paperwork on File
To be completed by District Human Resources:
_________________________________________________
Employee’s Signature
_________________________________________________
Administrator Initiating Agreement – signature & PRINTED NAME
_________________________________________________
Administrator Approving Agreement – signature & PRINTED NAME
__
(Date)
__
(Date)
Form 132-91 (Rev. 8/09)
Employee: Original
__
(Date)
________________________________________________________
Human Resources Administrative Approval
 STRS Creditable
 STRS Non-Creditable
Employment Status:
FICA ________
 Regular Employee
 Part-time Temporary Employee
Record No. ____________
Payroll: Copy
Human Resources: Copy
VP Administration: Copy
(Date)
RC _______________
Initials ____________
Date Processed _______________
Originator: Copy
PREPARING THE EMPLOYMENT SERVICE AGREEMENT (ESA)
1.
Please adhere to the following guidelines in preparing this document for processing:
A. ESAs are used to compensate certificated (academic) employees for certain types of assignments
that are not part of regular load or adjunct and overload service. ESAs should be written for one
semester at a time. (There is a greater opportunity for error and overpayment to occur if an ESA
is written for the entire year.)
However, if the assignment is for an entire year without a break, you may submit an ESA covering
the fiscal year only. Any portion that crosses the fiscal year must be submitted on a separate ESA.
B.
ESAs should not be submitted for classified employees. Classified employees’ work should be paid
as overtime (if they are non-exempt) or should be temporarily reclassified into a current position
and their time and salary reported on a P103A. Some ESA assignments are classified work or
CalPERS eligible assignments (Non-STRS Creditable), if the assignment falls under this category,
the employee should be given the appropriate PARS documentation.
2.
Please ensure the ESA includes the following items before submitting for processing:
A. Service dates that do not cross fiscal years.
B. A detailed description of the type of service to be performed and how payment is to be made.
C. Position number AND budget number. (All non-STRS creditable ESAs must have a 2305 Account
code.)
3.
Fingerprinting / TB Test:
In a continued effort to provide a safe environment for our students and staff, all individuals hired on ESAs,
are to be fingerprinted and have a current TB test on file.
4.
STRS Service Credit:
For purposes of computing service credit for the State Teachers' Retirement System (STRS), full-time
equivalent service for part-time faculty is defined as follows:
 540 lecture hours per fiscal year
 720 laboratory hours per fiscal year
 1305 counselor/coordinator/nurse hours per fiscal year
 1230 librarian hours per fiscal year
*In addition, full-time faculty have the following requirements such as, but not limited to, office hours,
governance and committee participation.
(reference: Education Code 22138.5)
5.
STRS Earning Limitation:
Retired STRS members should visit the STRS website at:
http://www.calstrs.com/Help/faqs/PRELfaqs.aspx to learn about their annual earnings limitations.
6. Duties creditable toward 67% law will be reviewed for compliance by the District Human Resources Office.
If you have questions, please contact the Human Resources Specialist at (916) 568-3179.
For additional information, please visit our ESA web site located at:
http://www.losrios.edu/hr/ESA%20Page/New_ESAWebPage.htm