Welcome to Klein ISD
Congratulations and welcome to your new position at Klein ISD. As part of our
hiring process, we ask that you follow the hiring steps listed below:
1. If your position requires certification and you are not already holding a current
certificate, please review the information listed under the “Certification” section
on the New Hire Packet web page.
2. Read the “Frequently Asked Questions Sheet”. The FAQ sheet can be found
under the “Important Links” section.
3. Download, print (single sided only) and bring with you the completed
“Professional/Teacher New Hire Packet”. The appropriate packet is attached to
this Welcome page. You will also need to bring your unexpired drivers license
and social security card.
Your Human Resource Specialist will contact you soon to set up an appointment to
complete the hiring process and answer any questions you may have.
We wish you all the best!!!!
Instructions for
New Hire Professional/Teacher Paperwork
Information Requiring Action and Signatures
The items following this instruction sheet will need to be downloaded, completed with
required information and signed. All forms in red must be brought with you on your
contract signing day. Please print all forms single sided.
•
TEA Staff Ethnicity and Race Questionnaire (Part l and Part 2) –
Make selection from Part 1 and Part 2
Sign, Date and add your Employee ID that was given to you by your HR
Specialists.
•
W-4 Form –
Complete bottom section of form, sign and date. We only need the 1st
page with your signature and not the worksheet.
•
Statement Concerning Your Employment in a Job Not Covered by Social Security
Fill in information at top (Name and Social Security Number)
Sign and Date both copies
•
I-9 Form –
Fill in Section 1, sign and date
Bring in your current Drivers License and Social Security Card on the
day of your contract signing.
Acceptable Documents are listed on page 3 of the I9 Form
•
ESL Requirement Form –
This information covers the ESL requirements for all teachers. Review all
ESL Requirements under “Important Links”. The ESL Requirements
were acknowledge and agreed upon on your Letter of Intent.
•
Bilingual Requirements –
This section is for Bilingual Teachers and Bilingual Support Staff ONLY.
Go to the Bilingual Requirements Section under “Important Links” and
complete the appropriate Bilingual Forms and bring with you on signing
day. You will also see the Bilingual Professional Development schedule
under this link.
•
Authorization Agreement for Direct DepositsBring this with you and you will take this to the payroll department on the
day of contract signing. You will need your bank routing numbers
•
Employee Acknowledgement of the Alliance Direct Contracting Program –
Please review this information under “Important Links”. Complete, sign
and date this page and bring with you.
•
Acknowledgement of Receipt of Benefits Information –
Complete, sign and date this form and bring it with you on signing day.
Important Links
These are links that may require action. Please review all links.
•
•
•
•
•
Requirements and Responsibilities for Teachers
New Instructional Employee Orientation
Bilingual Teacher/Support Staff
ESL Requirements
Acknowledgement of Alliance
General Information Links
These are links to general information for new hires. Please review all links.
•
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•
•
•
•
•
Human Resource Department Distribution List
Drug Prevention Program Certification
Policy Number C-10
Fraud Line Information
Employee Access Center – Preferred First Name
FICA Alternative Retirement Plan for Part-Time Employees
FAQ
Contract Signing Day Information
Your HR Specialist will call you for a signing appointment. At that time, you will be
given your Employee ID. In addition to these completed forms, these items will be
required or completed with your HR Specialist on your signing day:
•
You must bring with you your current drivers license and Social Security Card.
•
Bring with you your Original Official Transcript(s) with degrees posted and
Original Services Records if you have received them from your previous
employer. If you have requested these, please let your HR Specialist know at the
time of signing.
•
You will sign your Letter of Intent, Contract and turn in all signed New Hire
Packet documents.
•
You will have your photo taken and receive your school/department ID Badge.
•
NOTE: All personal phone numbers and addresses are kept confidential unless
otherwise requested.
Other Important Information for
New Employees
Required New Teacher Orientation Information:
Please review the New Teacher Information and the New Teacher Orientation Schedule
found under the “Important Links” section. This information applies to new teachers to
the profession as well as new teachers to the district.
Benefits Information:
It is important that you review all Benefits Information on the New Hire Web Page
“Benefits” link
• Enrollment Guide for Health Plans
• Klein ISD Benefits Plan Information Booklet
• Notice of Privacy Practices (HIPPA)
• NOTICE – Federal Affordable Care Act
• NOTICE – Federal Continuation of Coverage under COBRA
• NOTICE – KISD Workers’ Compensation Insurance
• Available Individual Retirement Plans
• Required Deduction for Medicare
REMEMBER: The Benefits meeting is required.
KLEIN INDEPENDENT SCHOOL DISTRICT 7200 Spring Cypress Road, Klein, Texas 77379 Phone: 832.249.4218 Fax: 832.249.4018
Texas Education Agency
Texas Public School Student/Staff Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education
institutions to collect data on ethnicity and race for students and staff. This information is used
for state and federal accountability reporting as well as for reporting to the Office of Civil Rights
(OCR) and the Equal Employment Opportunity Commission (EEOC).
School district staff and parents or guardians of students enrolling in school are requested to
provide this information. If you decline to provide this information, please be aware that the
USDE requires school districts to use observer identification as a last resort for collecting the
data for federal reporting.
Please answer both parts of the following questions on the student’s or staff member’s ethnicity
and race. United States Federal Register (71 FR 44866)
Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one)
Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or
other Spanish culture or origin, regardless of race.
Not Hispanic/Latino
Part 2. Race: What is the person’s race? (Choose one or more)
American Indian or Alaska Native - A person having origins in any of the original peoples
of North and South America (including Central America), and who maintains a tribal affiliation
or community attachment.
Asian - A person having origins in any of the original peoples of the Far East, Southeast
Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan,
Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black or African American - A person having origins in any of the black racial groups of
Africa.
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White - A person having origins in any of the original peoples of Europe, the Middle East, or
North Africa.
________________________________
Student/Staff Name (please print)
________________________________
Student/Staff Signature
________________________________
Student/Staff Identification Number
________________________________
Date
Texas Education Agency – March 2009
Revised: 10/27/2011
You do not have to return this sheet with your packet.
KLEIN INDEPENDENT SCHOOL DISTRICT
7200 Spring Cypress Road, Klein, Texas 77379
Phone: 832.249.4218 Fax: 832.249.4018
Statement Concerning Your Employment in a Job
Not Covered by Social Security
____________________________________________
Employee Name
___________________________________
Social Security Number
Klein Independent School District_______
Employer Name
74-6002337_____________
Employer ID#
Your earnings from this job are not covered under Social Security. When you retire, or if you become disabled, you may
receive a pension based on earnings from this job. If you do, and you are also entitled to a benefit from Social Security
based on either your own work or the work of your husband or wife, or former husband or wife, your pension may affect
the amount of the Social Security benefit you receive. Your Medicare benefits, however, will not be affected. Under the
Social Security law, there are two ways your Social Security benefit amount may be affected.
Windfall Elimination Provision
Under the Windfall Elimination Provision, your Social Security retirement or disability benefit is figure using a modified
formula when you are also entitled to a pension from a job where you did not pay Social Security tax. As a result, you will
receive a lower Social Security benefit than if you were not entitled to a pension from this job. For example, if you are age
62 in 2005, the maximum monthly reduction in your Social Security benefit as a result of this provision is $313.50. This
amount is updated annually. This provision reduces, but does not totally eliminate, your Social Security benefit. For
additional information, please refer to Social Security Publication, “Windfall Elimination Provision.”
Government Pension Offset Provision
Under the Government Pension Offset Provision, any Social Security spouse or widow(er) benefit to which you become
entitled will be offset if you also receive a Federal, State or local government pension based on work where you did not
pay Social Security tax. The offset reduces the amount of your Social Security spouse or widow(er) benefit by two-thirds
of the amount of your pension.
For example, if you get a monthly pension of $600 based on earnings that are not covered under Social Security, twothirds of that amount, $400, is used to offset your Social Security spouse or widow(er) benefit. If you are eligible for a
$500 widow(er) benefit, you will receive $100 per month from Social Security ($500-$400=$100). Even if your pension is
high enough to totally offset your spouse or widow(er) Social Security benefit, you are still eligible for Medicare at age 65.
For additional information, please refer to Social Security Publication, “Government Pension Offset.”
For More Information
Social Security publications and additional information, including information about exceptions to each provision, are
available at www.socialsecurity.gov. You may also call toll free 1-800-772-1213, or for the deaf or hard of hearing call the
TTY number 1-800-325-0778, or contact your local Social Security office.
I certify that I have received Form SSA-1945 that contains information about the possible effects of the Windfall
Elimination Provision and the Government Pension Offset Provision on my potential future Social Security benefits.
________________________________________________________
Signature of Employee
_______________
Date
KLEIN INDEPENDENT SCHOOL DISTRICT
7200 Spring Cypress Road, Klein, Texas 77379
Phone: 832.249.4218 Fax: 832.249.4018
Statement Concerning Your Employment in a Job
Not Covered by Social Security
____________________________________________
Employee Name
___________________________________
Social Security Number
Klein Independent School District_______
Employer Name
74-6002337_____________
Employer ID#
Your earnings from this job are not covered under Social Security. When you retire, or if you become disabled, you may
receive a pension based on earnings from this job. If you do, and you are also entitled to a benefit from Social Security
based on either your own work or the work of your husband or wife, or former husband or wife, your pension may affect
the amount of the Social Security benefit you receive. Your Medicare benefits, however, will not be affected. Under the
Social Security law, there are two ways your Social Security benefit amount may be affected.
Windfall Elimination Provision
Under the Windfall Elimination Provision, your Social Security retirement or disability benefit is figure using a modified
formula when you are also entitled to a pension from a job where you did not pay Social Security tax. As a result, you will
receive a lower Social Security benefit than if you were not entitled to a pension from this job. For example, if you are age
62 in 2005, the maximum monthly reduction in your Social Security benefit as a result of this provision is $313.50. This
amount is updated annually. This provision reduces, but does not totally eliminate, your Social Security benefit. For
additional information, please refer to Social Security Publication, “Windfall Elimination Provision.”
Government Pension Offset Provision
Under the Government Pension Offset Provision, any Social Security spouse or widow(er) benefit to which you become
entitled will be offset if you also receive a Federal, State or local government pension based on work where you did not
pay Social Security tax. The offset reduces the amount of your Social Security spouse or widow(er) benefit by two-thirds
of the amount of your pension.
For example, if you get a monthly pension of $600 based on earnings that are not covered under Social Security, twothirds of that amount, $400, is used to offset your Social Security spouse or widow(er) benefit. If you are eligible for a
$500 widow(er) benefit, you will receive $100 per month from Social Security ($500-$400=$100). Even if your pension is
high enough to totally offset your spouse or widow(er) Social Security benefit, you are still eligible for Medicare at age 65.
For additional information, please refer to Social Security Publication, “Government Pension Offset.”
For More Information
Social Security publications and additional information, including information about exceptions to each provision, are
available at www.socialsecurity.gov. You may also call toll free 1-800-772-1213, or for the deaf or hard of hearing call the
TTY number 1-800-325-0778, or contact your local Social Security office.
I certify that I have received Form SSA-1945 that contains information about the possible effects of the Windfall
Elimination Provision and the Government Pension Offset Provision on my potential future Social Security benefits.
________________________________________________________
Signature of Employee
_______________
Date
KLEIN INDEPENDENT SCHOOL DISTRICT
AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT (CREDITS)
SUBMITTING INSTRUCTIONS
1. Please sign form in any color, NO BLACK INK
2. Print out and bring this form to Klein Central Office – Payroll Room #211
3. Bring check for verification of your bank routing # and your account #
4. For identity theft protection please DO NOT submit via inter-school mail, fax or email.
Forms received by these methods will not be processed.
5. Retain one copy for your records.
NAME
KLEIN ID/ #
CHECK ONE: ___ADD NEW
___CHANGE EXISTING ___ CANCEL
CHECK ONE: ___CHECKING
___SAVINGS
___ CHANGE AMOUNT
Amount $________________
If no specific amount, write ALL.
If change, enter new amount.
BANK / DEPOSITORY NAME
BANK ROUTING #
Verified by payroll
ACCOUNT #_____________________
_____
(First nine digits on bottom of check)
Verified by payroll
_____
The KLEIN ISD is not responsible for overdraft charges that might result from an inactivated account. I hereby authorize KLEIN
INDEPENDENT SCHOOL DISTRICT hereinafter to initiate credit entries and, if errors occur, authorize correcting entries to my
ACCOUNT indicated below and the depositary name below to credit the same to such account credit entries or change amounts as
stated above:
SIGNATURE
DATE
Bank Code # ________
Bank Code #
578
OFFICE USE ONLY
Ded Code #
1530 – 1510 Checking
Circle One
1520 – 1500 Savings
Ded Code #
1501 – Smart Financial Saving
Date Entered: _________ Entered By: _________
EMPLOYEE ACKNOWLEDGMENT OF THE ALLIANCE
DIRECT CONTRACTING PROGRAM
I have received information that tells me how to get health care under my employer’s workers’
compensation coverage. If I am hurt on the job and live in a service area described in this information, I
understand that:
1. I must choose a treating doctor from the Alliance list of doctors designated as treating doctors.
2. I must go to my treating doctor for all health care for my injury. If I need a specialist, my treating
doctor will refer me. If I need emergency care, I may go to any licensed medical professional
within the United States.
3. Even though my treating doctor should refer me to a specialist of providers contracted with the
Alliance, I understand that I need to verify that the referral doctor is a member of the Alliance
provider panel.
4. The Texas Association of School Boards Risk Management Fund will pay the treating doctor
and other Alliance providers for all health care related to my compensable injury.
5. I may have to pay the bill if I receive health care from a provider other than an Alliance provider
without prior approval from the Fund.
6. Making a false or fraudulent workers’ compensation claim is a crime that may result in fines and
or imprisonment.
7. If I want to change doctors after my first choice, I can only choose from the Alliance list of
providers. A third choice requires approval from my adjuster.
_____________________________________________________
Signature
/
/
Date
Printed Name
I reside at: ____________________________________
Street Address
___________________,______,_________________
City
State Zip Code
Name of Employer: Klein ISD
Name of Direct Contracting Program: Political Subdivision Workers’ Compensation Alliance (the
Alliance)
Direct contracting service areas are subject to change. To locate a treating doctor within your area, visit
the PSWCA web site at www.pswca.org or call your adjuster at 800-482-7276.
To be completed by the employer only
Please indicate whether this is the:
Initial Employee Notification
Injury Notification (Date of Injury:
/
/
)
DO NOT RETURN THIS FORM TO THE TASB RISK MANAGEMENT FUND UNLESS REQUESTED.
EMPLOYEE ACKNOWLEDGMENT OF THE ALLIANCE DIRECT
CONTRACTING PROGRAM
RECONOCIMENTO DEL EMPLEADO PARA EL PROGRAMA DE CONTRATAR
DIRECTAMENTE CON MEDICOS
He recibido la información que explica como obtener tratamientos médicos si me lastimo en el
trabajo. También entiendo si me lastimo en el trabajo:
1. Tengo que escoger un doctor de la lista de Alliance (PSWCAA), que son designados para
tratar.
2. Tengo que ir al doctor escogido por mí para tratamiento relacionado a mi lastimadura. Si
necesito un especialista, el doctor que escogí tiene que referir me a ese especialista. Si
necesito tratamientos de emergencia, yo entiendo que puedo ir a cualesquier doctor
licenciado en los Estados Unidos.
3. Si el doctor que escogí me refiere a un especialista, tengo que verificar que el especialista
también es aprobado por la PSWCA.
4. La compañía TASB le pagara al doctor escogido por mí y a doctores también que son
partidos de PSWCA.
5. Si voy a un doctor que no es aprobado por TASB, y no pertenece al partido de la PSWCA,
y no he obtenido aprobación, entiendo que es posible que tendré que pagar esa cuenta.
6. Reportando un reclamo falso de lastimadura en el trabajo es un crimen que pueda resultar
en multas o encarcelamiento.
7. Si deseo cambiar doctor después del primer doctor escogido, nada mas puedo escoger de
la lista de doctores aprobados por PSWCA. Si deseo cambiar doctor por la tercera ves,
tendré que recibir aprobación de mi ajustador de la compañía TASB, antes de cambiar.
Signature (firma):______________________________ Date (Fecha)_________________
Printed Name (Nombre en imprenta): ___________________________________________
Address (Dirección de domicilio incluyendo cuidad, estado y zip):_____________________
_________________________________________________________________________
Employer (Nombre de empleador): Klein ISD
Nombre del programa de contratar doctores directamente: POLITICAL SUBDIVISION WORKERS’
COMPENSATION ALLIANCE (PSWCA)
El servicio de contratar doctores directamente en las áreas de servicio, son subjetivos a cambiar.
Para localizar un doctor de tratamiento en su área, visite al Internet en: www.pswca.org o llame a
su ajustador al numero: 800-482-7276.
To be completed by the employer only (Para completar por el empleador solamente)
Please Indicate whether this is the:
□ Initial Employee Notification
□ Injury Notification (Fecha de lastimadura _________)
DO NOT RETURN THIS FOR TO THE TASB RISK MANAGEMENT FUND
UNLESS REQUESTED. (NO REGRESE ESTA FORMA A TASB SOLO QUE SEA
REQUERIDA)
TIME SENSITIVE
(All new hires MUST complete benefit enrollment process within 30 days of hire date)
Acknowledgement of Receipt of Benefits Information
I understand that I have 30 days from my first day of employment to elect my benefits, including medical, dental, vision, life, critical
care, and legal plan options. I understand that if I do not enroll within 30 days, my benefits will be waived/declined on my behalf
by Klein ISD. I will be required to wait until the next annual enrollment period, unless a qualified event occurs.
www.mybenefitshub.com/kleinisd
I have been informed/told that even if I do not want any benefits I must go through the enrollment process system in order to
officially decline the medical coverage (per the ACA Federal requirement) and also to designate a beneficiary for the $10,000
Basic Life and Accidental Death policy provided by Klein.
I understand that I have the responsibility to educate myself on the available KISD Benefits. I have been told that I can attend a
Benefit Meeting* (www.kleinisd.net/benefits ) to obtain benefit enrollment information prior to signing up for benefits.
I also will review all Benefit Information available to me under the “Klein ISD Benefits” link on the New Hire Packet Page, I
understand that all the benefit materials is available to me on-line, accessible from the Benefit Department website
(www.kleinisd.net/benefits). This website is accessible from any computer at www.kleinisd.net
Important and Required for Benefits




Logon to the www.mybenefitshub.com/kleinisd
Enroll in benefits or waive benefits.
Assign a beneficiary for the $10,000 life insurance policy and the Accidental Death policy given to you by KLEIN ISD
Print or email – Summary of Elected Benefits for my records
_____________________________________
________________________________
Printed Name
Employee ID #
_____________________________________
________________________________
Hire Date
Campus/Department
_____________________________________
________________________________
SIGNATURE
Date
 The Informational Benefit Meeting schedule – www.kleinisd.net/benefits

No Registration is required – just BE THERE!
ACKNOWLEDGEMENT OF RECEIPT OF BENEFITS INFORMATION – REVISION 11/2016 |