These forms are only to be completed by individuals already hired for employment. Print and complete all forms below. Then contact Sarah Andrews, Benefits Personnel Specialist, 610-799-1303 or andrewss@lcti.org for an appointment to submit and review all required paperwork.

New Employee Checklist

To Do Items:

• HEALTH / PHYSICAL FORM | Physical and TB test required at employee cost prior to hire.
• ACT 34 – PA CRIMINAL CLEARANCE  | Apply Online | Print certificate and present to LCTI.
• ACT 151 – CHILD ABUSE CLEARANCE | Apply Online| Present original to LCTI upon receipt.
• ACT 114 – FBI CRIMINAL BACKGROUND CHECK | UEID for Act 114 – Link to start fingerprinting process
  • Follow the link to IdentoGO to schedule a fingerprinting appointment and submit payment.
  • Take required IdentoGO documentation and acceptable form of ID to one of the listed Enrollment Centers for fingerprinting.
    • The closest to LCTI is 1382 Hanover Avenue, Allentown, PA
  • Information on Federal Criminal History Background Checks

Forms To Complete:

• PDE 6004 Arrest/Conviction Report Form
• PA Sexual Misconduct-Abuse Disclosure Release Form DPTT
  • Complete the Name/Address/Phone of current/former employer and Section 1 only
  • By law as of 12/22/14, one form must be completed for each of the following:
    • Current Employer
    • Each former employer that was a school entity
    • Each former employer where you were employed in a position that involved direct contact with children
• DIRECT DEPOSIT SIGN-UP FORM | Please provide a voided check or bank letter verifying ABA # and Bank Account$
• FORM W-4
• FORM I-9 | Instructions | Please provide, in person, original form(s) of identification as per page 3
• ACT 32 LOCAL TAX FORM
• LOCAL SERVICE TAX (LST) FORM | APPLICATION FOR EXEMPTION FROM LST TAX  (Complete only if requesting exemption)
• ACT 29 – Prior PSERS Employment
• WORKER’S COMPENSATION – EMPLOYEE’S RIGHTS AND DUTIES
• WORKER’S COMPENSATION INFORMATION
• WORK RELATED INJURY  PROCEDURES
• COMPLETE ONLINE ASSIGNED TRAINING VIDEOS – You will receive an email with instructions. Please complete ASAP.
• AUTODIALING CONFIRMATION AND PHONE NUMBER REQUEST FORM
• SIGN-OFF SHEET | LCTI POLICY #815 – INTERNET ACCEPTABLE USE POLICY
• SIGN-OFF SHEET THAT EACH OF THE FOLLOWING DOCUMENTS WERE READ
  Select each of the following and read:
  • RIGHT-TO-KNOW BOOKLET
  • PRIVACY PRACTICES NOTICE
  • PSERS NEW EMPLOYEE INFORMATION 7-19
  • OPTIONAL 403(b) PLAN INFORMATION
  • AESOP SUBSTITUTE WEB GUIDE OR AESOP EMPLOYEE WEB GUIDE
  • AESOP SUBSTITUTE PHONE GUIDE OR AESOP EMPLOYEE PHONE GUIDE
  • HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS NOTICE
  • NO SURPRISE BILLING ACT MODEL NOTICE

Additional forms may be required based on employee group

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