Forms
All Forms are electronic & secure. If you encounter an issue with one of the forms below, please email payroll@legacypca.com for assistance.
CURRENT EMPLOYEE FORMS
FINAL batch of 2023 W2's were mailed to the address on record January 29, 2024.
Utilize this form to notify payroll of a change in your primary, secondary, or savings account.
Utilize this form to update your tax liability. This form affects the amount of taxes withheld from your paycheck This form has no bearing on Social Security or Medicare deductions. Click here to view pages 2-4 of this form
This form will notify both payroll & benefits to update your address.
Utilize this form to report a qualifying life event (QLE) to benefits. QLE notification must be received within 30 calendar days of the event in order to be eligible to update benefit elections.
Employee's wishing to request FMLA must complete this form to begin the process. It is highly recommended that employees begin this process no later than 30 days prior to the first estimated day of absence.
The purpose of this form is to provide payroll with your permission to utilize your paid time off (PTO) in place of an unpaid day (dock). This form will stay in effect for your employment duration unless revoked in writing.
Utilize this form to request payment for RTI, LPAC, RTI, GT, 5+ Prep, or other one-time supplemental duties not paid by timesheet.
Utilize this form to request payment for performing coaching duties at an athletic game. This form does not act as a submission for mileage reimbursement.
Utilize this form to submit a request for the Bi-Annual Mentor stipend.
Utilize this form if you were not absent during the Fall or Spring semester's (respectively) to receive up to $250 payment each semester.
Employees must use this form to submit proof of Total Wellness Assessment survey completion in order to receive a higher contribution rate towards elected medical insurance premiums.
Utilize this form if you and your spouse are LPCA employees and would like to apply both LPCA contributions to a single healthcare plan premium.
The purpose of this form is to allow employees who are enrolled in a high-deductible healthcare plan to enroll in an HSA or modify existing HSA contributions. This form may be completed once per month & is not restricted to Qualifying Life Events (QLE) or Open Enrollment(OE) periods.
TRUE TIME REQUESTS
Click here for approved the participant template.
Approved Proposal is required for submission.
True Time setup request must be submitted no later than 2 weeks prior to the first day of work and is only applicable for ongoing programs
The purpose of this form is to notify payroll of any changes to the original participants.
This form cannot be submitted if a True Time Setup Request has not been submitted & completed.
Utilize this form only if you have been directed to do so by payroll or your campus manager. Most True Time corrections can be completed by returning the electronic timesheet.
FORMER EMPLOYEES ONLY
The forms below should only be utilized by employees whom are no longer actively employed with LPCA.
Former employees may utilize this form to request pay stubs be mailed to your home address. Note: this form does not replace the address update form.
A Gov't-issued photo ID required. This form will notify both payroll & benefits to update your address.
Utilize this form if you would like Payroll to reprint and redistribute a 1095-C and/or W-2.
There is a fee associated with this request.