KCI Head Start Centers



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Staff UpdatesStaff Documents • Forms Directory • Professional Development

Forms Directory

This directory is a collection of all forms currently used by Kids Central, Inc. to document services to children and families as well as management and operation of the Head Start and Early Head Start programs.

AdministrationDisabilitiesEducationFamily & Community Parnership
HealthNutritionTransportation

Administration Forms

The Administration Forms should be processed through the office of Executive Director, Darrell Edwards.

A-100

Sign-In Sheet

Used to document attendance at meetings

A-101

Telephone Log

Used to document calls made and received by agency sites

A-102

Staff Agreement

Used to document agreement between KCI and staff regarding hours and payment

A-103

Personal Time Off Request

Used to request personal time off

A-104

Volunteer Time Sheet

Used to document hourly volunteer activity for in-kind

A-105

Group Activity Time Sheet

Used to document volunteer in-kind for group activities

A-106

Statement of In-Kind Contribution

Used to document in-kind donations

A-107

Purchase Requisition

Used to request goods or services for program operation

A-108

Travel Advance Request

Used to request advance for travel expenses

A-109

Expense Reimbursement

Used to request reimbursement for out-of-pocket expenses

A-111

Hourly Wage Timesheet

Used to document time worked for hourly wage employees

A-112

Salary Exempt Timesheet

Used to document work time for salary exempt employees

A-113

Payroll Deduction Authorization

Used to allow KCI staff to withdraw funds from payroll for authorized reasons

A-114

Reimbursement for local travel

Used to document local travel and submit requisition for reimbursement

A-115

Benefits Pay Agreement

Used to document agreement between employee and KCI to repay benefits paid by the agency during authorized leave

A-116

Report of Tuberculosis Screening

Used to document results of Tuberculosis Screening as required by Virginia Licensing Standards

A-117

Sworn Statement of Affirmation

Used to document disclosure of information required for pre-employment by Virginia Licensing Standards

A-118

Staff Grievance Form

Used to document grievances relating to personnel matters

A-119

Personnel Action Form

Used to document resignation or termination of employment

A-120

Progressive Counseling Form

Used to address personnel matters intended to improve employee performance

A-121

Family Medical Leave Request

Used to notify staff of status of  request for FMLA leave

A-122

Return to Work Certification

Used to obtain certification for a medical provider that employee may return to work

A-123

Staff Orientation Period

Used to document 30-60-90 day evaluations during orientation period

A-124

Classroom Checklist

Classroom, Facilities, Grounds, and Bus Checklist

A-125

Disciplinary Action Form

Used to document employee actions requiring disciplinary action

A-126

Employee Termination Checklist

Used to verify that property belonging to KCI is returned in the event of employee termination

A-127

Exit Interview

Used to conduct exit interview with employees leaving employment at KCI

A-128

Employee Accident Form

Used to report accidents on the job

A-129

Employee Physical Form

Not for Bus Drivers

A-130

30 Day Evaluation

Used to document 30 day evaluations during orientation period

A-131

90 Day Evaluation

Used to document 90 day evaluations during orientation period

A-132

180 Day Evaluation

Used to document 180 day evaluations during orientation period

A-133

Performance Evaluation & Professional Development Plan

Used to highlight HS regs and guidelines and to identify key performance indicators for professional growth and development.

A-134

Personal Time Off Transfer Request

Used to donate PTO to another eligible employee in times of extreme illness.

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