Print this checklist and return completed forms to your department representative or Human Resources in Room C-2089, Monday through Friday from 8 a.m. - 5 p.m.
*(required) please fill in information on this sheet

*Your name: *Your department:

Employment Application

Required. ALL Lakeland employees must have an employment application on file.

I-9 Form

Required. ALL Lakeland employees within three business days of the first day of work.

Fingerprint Control Form for Employment

Disclosure and Authorization Form


Required. As part of our ongoing commitment to ensuring the safety of our students, employees, and visitors, we require all finalists for employment with the College to submit their fingerprints to the Ohio Bureau of Criminal Identification and Investigation (and Federal Bureau of Investigation, as appropriate) in order to obtain a criminal history background report Convictions do not automatically preclude employment with the College. Several factors are considered when evaluating a candidate's criminal conviction history relative to his/her eligibility for employment with the College. These factors include the nature of the crime, the time that has elapsed since the conviction, and/or relevance to the position for which the candidate has applied and is being considered.

The Human Resources Department, located in Room C-2089, is equipped to capture a digital image of your fingerprints and submit them to the appropriate agency. There is no need to schedule an appointment and the department is staffed for fingerprinting, Monday – Friday from 7:30 AM to 4:30 PM. Before reporting to the Human Resources Department, you will need to: 1) complete and print the Fingerprint Control Form for Employment (2 pages) and 2) print and sign the Disclosure and Authorization form. Please bring the completed and signed forms with you, along with your driver's license or state-issued photo ID.

Personal Data Sheet

Required. All information is kept confidential and separate from your personnel file.

State of Ohio Fraud Reporting System Required. ALL employees must complete this document.


Direct Deposit Authorization Required. Authorization Agreement for Direct Payroll Deposit.
State of Ohio Department of Taxation Employee's Withholding Exemption Certificate Required Ohio Department of Taxation, Form IT-4.
W-4 Required. Federal Internal Revenue Service Form W-4, Employee's Withholding Allowance Certificate.
Optional Resident Tax Withholding Authorization Optional: Residence Tax Withholding Authorization Form.
Statement Concerning Your Employment in a Job Not Covered by Social Security Required
SERS Membership Required. Required for Lakeland staff employees including continuing education instructors.
STRS Membership Required for Lakeland faculty employees teaching credit classes.
Student Exemption Optional. A Lakeland student may choose to be exempt from membership in SERS/STRS only if enrolled in a minimum of six credits for fall and spring semester.


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