2/2013

Administrative

ADMINISTRATIVE EMPLOYEE CHECKLIST

Dept: __________________________

Title: __________________________

Hire Date: __________________________

Badge: __________________________

I have received and/or completed the following items:

OCTA Policies & Programs

___ 1. Leave of Absence Policy

___ 2. EEO Policy (no signature required)

___ 3. Oath Policy (please do not sign until asked)

___ 4. Code of Conduct

___ 5. Workplace Harassment Policy & Brochure

___ 6. Workplace Violence Prevention Policy

___ 7. Employee Qualification to Drive Motor Vehicles Policy

___ 8. Employee Pull Notice Program (Optional)

___ 9. Reporting Arrests, Convictions & Traffic Citations Policy

___ 10. Drug & Alcohol Policy Manual

___ 11. General Office Code and Safety Practices Memo

___ 12. Internet Acceptable Use Policy

___ 13. Software Compliance Policy

___ 14. Electronic Mail Policy (no signature required)

___ 15. Dress Code Policy (no signature required)

___ 16. Transportation Picture Pass ID Request*

Mandatory Benefits:

___ 1. I-9 Employment Eligibility Verification

___ 2. W-4 form

___ 3. Social Security Information Form SSA-1945

___ 4. OCERS Affidavit (Adm or TCU)

___ 5. Direct Deposit form (optional)

- State Disability Insurance

- Paid Family Leave

- Workers’ Comp Pamphlet / Memo

- Time of Hire Pamphlet

Informational Material

___ 1. Biweekly Timesheet

___ 2. The Work Number Brochure

___ 3. Disaster Service Workers

___ 4. Parking Rules & Regulations

___ 5. 2013 Holiday Schedules

___ 6. HR Contacts

___ 7. I.S. Security pamphlets

___ 8. Personnel & Salary Resolution

Employee Name (Print)

Employee Signature 1

ACKNOWLEDGEMENT OF RECEIPT OF OCTA LEAVE OF ABSENCE POLICY

I, the undersigned, have received a copy of the Orange County Transportation Authority (OCTA) Leave of Absence Policy, which provides eligible employees with leave of absence information in accordance with all applicable state and federal laws. This policy includes information on the procedure for requesting a leave of absence. I understand that it is my responsibility to inform OCTA if I need to take a leave of absence, and of the period of time for which the leave of absence is requested. As a provision, the Leave of Absence Policy will be interpreted and applied in accordance with the Federal Family and Medical Leave Act, the California Family Rights Act, regulations there under, and all other applicable laws, and to the extent that this policy may conflict with those laws, they are controlling over this policy. I understand and acknowledge that it is my responsibility to read and comply with the information contained in this policy. ____________________________________ ______________________ Employee Name (Print) Employee Badge # Employee Signature Date

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OATH ACKNOWLEDGEMENT FORM

I do solemnly swear (or affirm) that I will support and defend the Constitution of the

United States and the Constitution of California against all enemies foreign and

domestic; that I will bear true faith and allegiance to the Constitution of the United

States and the Constitution of the State of California; that I take this obligation freely,

without any mental reservation or purpose of evasion; and that I will well and faithfully

discharge the duties upon which I am about to enter.

_________________________________ Employee Name Printed

_________________________________

Employee Signature

Subscribed and sworn to before me this:

_________________________________

Date

_________________________________ Witness Signature

(This oath is required by Section 3100 et. Seq. of the Government Code.)

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Code of Conduct Policy

ACKNOWLEDGEMENT OF RECEIPT

I have received a copy of the Orange County Transportation Authority’s

(Authority) Code of Conduct Policy. I understand and acknowledge by my signature

below that I am expected to read, understand and adhere to this policy. Furthermore, I

understand that compliance with this policy is a condition of my employment and that if I

violate any provision of this policy, I may be subject to disciplinary action, up to and

including discharge.

________________________________ ________ _________________ Employee Name (Print) Employee ID # _________________________________________ _________________ Employee Signature Date

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WORKPLACE HARASSMENT AND DISCRIMINATION PREVENTION POLICY

ACKNOWLEDGEMENT OF RECEIPT

I have received a copy of the Orange County Transportation Authority (OCTA)

Workplace Harassment and Discrimination Prevention Policy. I understand and

acknowledge by my signature below that compliance with this policy is a condition of my

employment.

Further, I understand that it is my responsibility to read, understand, and comply

with this policy.

________________________________ ________ _________________ Employee Name (Print) Employee ID # _________________________________________ ________________________ Employee Signature Date

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Workplace Violence Prevention Policy

ACKNOWLEDGEMENT OF RECEIPT

I have received a copy of the Orange County Transportation Authority (OCTA)

Workplace Violence Prevention Policy. I understand and acknowledge by my signature

below that compliance with this policy is a condition of my employment.

Further, I understand that it is my responsibility to read, understand, and comply

with this policy.

________________________________ ________ _________________ Employee Name (Print) Employee ID # _________________________________________ ________________________ Employee Signature Date

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EMPLOYEE QUALIFICATION TO DRIVE MOTOR VEHICLES POLICY

ACKNOWLEDGEMENT OF RECEIPT

I have received a copy of the Orange County Transportation Authority (OCTA)

Employee Qualification to Drive Motor Vehicles Policy. I understand and acknowledge

by my signature below that compliance with this policy is a condition of my employment.

Further, I understand that it is my responsibility to read, understand, and comply

with this policy.

________________________________ ________ _________________ Employee Name (Print) Employee ID # _________________________________________ ________________________ Employee Signature Date

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Equivalent to DMV INF 1101 / Revised 01/2011 Available to DMV Staff Upon Request

Pull Notice Program Enrollment / No-Drive Provision Declaration Send Completed Form by Inter-Office Mail to “EPN - Labor & Employee Relations, 550 Bldg”

Please Review Policy #450.08 – Employee Qualification To Drive Motor Vehicles. Check Only One Option.

Option A: I request to drive a motor vehicle under Policy #450.08. Enroll me in the Pull Notice Program. Complete the “Authorization of Release of Driver Record Information” section. Complete

and sign the “Personal Information & Signature” section.

Option B: I elect the No-Drive Provision. I hereby declare that I will not drive an Authority owned or leased motor vehicle or drive a privately owned motor vehicle as described in Policy #450.08. Complete and sign only the “Personal Information & Signature” section.

Option A Only - Authorization of Release of Driver Record Information I hereby authorize the California Department of Motor Vehicles (DMV) to disclose or otherwise make available, my driving record, to my employer, the Orange County Transportation Authority. I understand that my employer may enroll me in the Employer Pull Notice (EPN) program to receive a driver record report at least once every twelve (12) months or when any subsequent conviction, failure to appear, accident, driver’s license suspension, revocation, or any other action is taken against my driving privilege during my employment. I am not driving in the capacity that requires mandatory enrollment in the EPN program pursuant to California Vehicle Code (CVC) Section 1808.1(k). I understand that enrollment in the EPN program is in an effort to promote driver safety, and that my driver license report will be released to my employer to determine eligibility as a licensed driver for my employment. Enter Your California Driver License # Here:

Personal Information & Signature

First Name: _____________________________Last Name: ______________________________________ Badge#: __________ Job Title: _____________________________________________________________ Supervisor: ______________________________ Department: ____________________________________ Executed at the City of: ______________________ County of: _________________ State: ____________

Your Signature: _________________________________________________ Date: ___________________

DO NOT WRITE IN THIS BOX

I do hereby certify under penalty of perjury under the laws in the State of California, that I am an authorized representative of the Orange County Transportation Authority, that the information entered on this document is true and correct, to the best of my knowledge and that I am requesting driver record information on the above individual to verify the information as provided by said individual. This record is to be used by the Orange County Transportation Authority in the normal course of business and as a legitimate business need to verify information relating to a driving position not mandated pursuant to CVC Section 1808.1. The information received will not be used for any unlawful purpose. I understand that if I have provided false information, I may be subject to prosecution for perjury (penal Code Section 118) and false representation (CVC Section 1808.45). These are punishable by a fine not exceeding five thousand dollars ($5,000) or by imprisonment in the county jail not exceeding one year, or both fine and imprisonment. I understand and acknowledge that any failure to maintain confidentiality is both civilly and criminally punishable pursuant to CVC Sections 1808.45 and 1808.46. Executed at City of Orange, County of Orange, State of California

EPN Program Coordinator Signature:____________________________________________Date:__________________

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REPORTING ARRESTS, CONVICTIONS AND CITATIONS POLICY

ACKNOWLEDGEMENT OF RECEIPT

I have received a copy of the Orange County Transportation Authority (OCTA)

Reporting Arrests, Convictions and Citations Policy. I understand and acknowledge by

my signature below that compliance with this policy is a condition of my employment.

Further, I understand that it is my responsibility to read, understand, and comply

with this policy.

________________________________ ________ _________________ Employee Name (Print) Employee ID # _________________________________________ ________________________ Employee Signature Date

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ACKNOWLEDGEMENT OF RECEIPT OF OCTA DRUG AND ALCOHOL POLICY MANUAL AND

CONSENT TO DRUG AND ALCOHOL TESTING

I, the undersigned, have received a copy of the Orange County Transportation Authority (OCTA or Authority) Drug and Alcohol Policy Manual, which complies with the Federal Transit Administration (FTA) and U.S. Department of Transportation (DOT) regulations, 49 CFR Part 40 and Part 655 as amended. I understand that nothing in this publication is intended to supplement, alter or serve as an official interpretation of 49 CFR Part 40 or DOT agency regulations. I understand and acknowledge that compliance with this Policy is a condition of my employment and that if I violate any provision of this Policy I will be subject to disciplinary action, which may include termination of employment. Further, I understand that it is my responsibility to read, understand and comply with the Drug and Alcohol Policy Manual. For employees performing safety-sensitive functions, I hereby consent for the Authority to collect breath and/or urine samples from me to determine the presence of alcohol, through the use of an Evidential Breath Testing Device (EBT), and/or the presence of drugs or their metabolites under the circumstances specified in the OCTA Drug and Alcohol Policy Manual to the certified laboratory designated by the Authority, to the analysis of the specimen for controlled substances and to the release of test results from that analysis to the Medical Review Officer (MRO) designated by the Authority. I further understand that the quantitation of the positive test arising from any verified positive drug or alcohol test may be revealed to the Authority or legal counsel or the decision-maker in a lawsuit, grievance, or as required by a federal, state or local agency, or other proceeding initiated by or on behalf of me. __________________________________________ __________________________ Employee Name (Print) Employee Badge # _______________________________________________ Employee Signature _________________________________ Date

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Safety Commitment Acknowledgement Dear Fellow Employee: Health, Safety & Environmental Compliance (HSEC) would like to thank each of you for your support and participation in Orange County Transportation Authority’s strong safety program. It is truly the efforts of each employee that continue to make our program successful. OCTA is adapting to the changing times; however, we remain firmly dedicated to providing a safe and healthy workplace for our employees and the public we serve. We invite you to join us in rededicating ourselves to safety excellence by filling in the statement at the bottom of this letter and returning it to the Health, Safety and Environmental Compliance Department. Your commitment involves the following:

• Taking responsibility for your own personal safety and alerting others of possible hazards or danger.

• Promptly reporting injuries that you have sustained on the job.

• Maintaining good health and fitness levels in order to reduce injuries and safety risks.

• Understanding and abiding by OCTA health, safety, and environmental compliance policies as they relate to your work tasks.

• Protecting the environment by not knowingly releasing contaminants into the environment and by properly recycling all appropriate waste.

• Being aware of and avoiding hazards that are in your immediate work environment.

• Reporting safety concerns and taking appropriate action to prevent an injury before it becomes a more serious incident.

I am committed to: making my workplace safer, being mindful of my health and fitness, and remaining aware of my safety as well as the safety of my colleagues and the general public. Employee Name (print) Employee Signature Date Badge Number Return to: HSEC, Building 550, Room 119.

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INTERNET POLICY ACKNOWLEDGMENT FORM

I ___________________________, recognize and understand that all electronic communications systems including but not limited to the Internet and all communications and stored information transmitted, received, or contained in OCTA’s information system are the property of OCTA and as such are to be used for job related purposes as provided in the OCTA Internet Policy. I understand that the use of such equipment and software for any other purpose, including but not limited to content or use related to sex, illegal drugs, illegal activities, hate speech, on line gambling, violence or offensive humor is prohibited.

I understand that information and messages created, stored, sent or received are considered OCTA records and are subject to access and review by management and authorized Information Systems personnel. I will not deliberately perform acts that waste OCTA resources or misuse OCTA resources impairing my or other employees’ productivity. Further, I agree not to use my code, access a file or retrieve any stored communication other than where authorized, unless there has be prior appropriate clearance. I am aware violations of this policy may subject me to disciplinary action, up to and including discharge from employment or termination of contract. I have been notified that authorized representatives of OCTA may monitor the use of the OCTA communications equipment from time to time to ensure that the use of such equipment is consistent with the OCTA’s legitimate business interests. Further, I am aware that the use of my OCTA-provided password or code does not in any way either restrict OCTA’s right to access my electronic communications or confer any right of privacy.

________________ __________________________ Date Signature

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Executive Office SOFTWARE LICENSE COMPLIANCE POLICY

Policy#: EO-IS-380.01S0FTWARELI Origination Date: 11/14/1994 Revised Date: 12/30/2010

SOFTWARE LICENSE COMPLIANCE AGREEMENT

Please read the attached Software License Compliance Policy, sign where provided below and return to Human Resources Department.

Employee Name:

Employee Signature: Date:

EO-IS380.01 SOFTWARELlC.docm (12/30/10) Page 3 013 13

TRANSPORTATION PICTURE PASS ID REQUEST Orange County Transportation Authority Employees Only

HROD-EMP-019.doc (10/02/07) Page 1 of 1

All OCTA employees are eligible to receive a Transportation Picture Pass ID. This policy affects all active employees and their dependents (up to age of twenty-one (21) and a student. Proof of enrollment in a college or university is required), retired employees and their spouses, and spouses of deceased employees. Please return this completed form to the Personnel Division with at least seven days advance notice prior to any picture taking appointment to allow for document preparation. To schedule an appointment, please call 714-560-5600. Employee: Badge Number: Work Location: OCTA Division : Hire Date: Employee Group: Operations Maintenance Administration

I am requesting a Pass ID for myself and/or my dependents listed:

DEPENDENT BIRTH DATE RELATIONSHIP Please Note: Passes for employee dependents can only be issued after you, the employee, have completed your introductory period. Length of introductory periods are:

Coach Operators: 120 Active Calendar Days Serviceworker: 150 days Mechanics: 150 days

Employee Signature: Date:

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