Human Resources

Membership fees will be deducted automatically from your paycheck each month.
Payroll deduction will run for 12 consecutive months.
Membership will automatically renew unless canceled before the renewal date.
You authorize Lebanon Public Schools to deduct the selected monthly fee from your paycheck.
Membership rates may change based on fitness center pricing.
The fitness center will notify you of any rate changes.

Submission Instructions

Select your location and membership type.
Sign and date this form.
Submit the completed form to Payroll at Central Office.
Additional membership paperwork must also be completed at the selected fitness center before submitting this payroll agreement.

403 (b) Universal Availability Notice

Download 403 (b) Universal Availability Notice

Heading 2: 403(b) Universal Availability Notice

Lebanon R-III School District

Looking for help?

View your plan details online: OMNI Plan Detail Page
https://www.omni403b.com/PlanDetail

Did you know about your 403(b) benefit?

You have the opportunity to save for retirement by participating in your employer’s 403(b) retirement plan. A 403(b) plan is a retirement plan for certain employees of public schools, tax-exempt organizations, and ministries.

We recommend that all employees visit OMNI’s education page:
www.omni403b.com/Employees/Education

Why save with a 403(b)?

You do not pay income tax on allowable contributions until you begin withdrawals (usually after retirement).
Investment gains in the plan are not taxed until distribution.
Generally, retirement assets can be carried from one employer to another.

How to participate

Before contributing, you must open an account with an investment provider authorized in the plan. A list of approved providers is included below.

After opening your account, complete a Salary Reduction Agreement (SRA) online at:
www.omni403b.com/SRA

If you are already contributing and want to change your contribution amount or investment provider, complete and submit a new SRA.

You can begin or change contributions as soon as your next payment cycle following receipt of a completed SRA.

Contribution limits (2026)

In 2026, you may contribute:

Up to $24,500 if you are age 49 and under (as of 12/31/2026).
Up to $32,500 if you are age 50 to 59, or age 64 or older (by 12/31/2026).
Up to $35,750 if you are age 60 to 63 (as of 12/31/2026).

You may also be entitled to additional catch-up provisions, such as the 15-Year Service Catch-Up. Please contact OMNI’s Customer Care Center at 877-544-6664 for details.

15-Year Service Catch-Up (if eligible)

Additional catch-up amount: $3,000

Combined limits for elective and non-elective contributions (2026)

Combined limits for elective and non-elective contributions:

$72,000 if age 49 and under on 12/31/2026.
$80,000 if age 50 to 59, or age 64 or older by 12/31/2026.
$83,250 if age 60 to 63 as of 12/31/2026.

Maximum employer contribution: $72,000

Future retirement savings value (example only)

Assumes 6% growth.

Monthly contribution: $50

5 years: $3,489
15 years: $14,541
20 years: $23,102

Monthly contribution: $200

5 years: $13,954
15 years: $58,164
20 years: $92,408

Monthly contribution: $500

5 years: $34,885
15 years: $145,409
20 years: $231,020

Approved service providers

Ameriprise Financial RiverSource
Aspire Financial Services
Corebridge Financial (formerly AIG VALIC)
Equitable (formerly AXA)
Fiduciary Trust Co of New Hampshire
Fiduciary Trust Intl / Franklin Templeton
Roth Aspire
Roth Corebridge Financial (formerly AIG VALIC)
Roth Equitable (formerly AXA)
Roth Security Benefit
Roth Voya Financial (ReliaStar)
Security Benefit
Voya Financial (ReliaStar)
Aspire Financial Services 457
Corebridge Financial (formerly AIG VALIC) 457
Equitable (formerly AXA) 457
Fiduciary Trust Co of New Hampshire 457
Putnam Investments 457
Security Benefit 457
Voya Financial (ReliaStar) 457

Direct Deposit Form

Download: Direct Deposit Authorization Agreement (PDF)

Direct Deposit Authorization Agreement

Lebanon R-III School District — Payroll Department

Direct Deposit (ACH Credits)

Authorization

I authorize Lebanon R-III School District (the “Company”) to initiate credit entries and, if necessary, debit entries and adjustments for any credit entries made in error to the checking and/or savings account(s) listed below at the bank named below (the “Depository”). The Depository is authorized to credit and/or debit the same to such account(s).

Important Information

If you are depositing to two different banks, please complete one form per bank.
Payroll checks are deposited on the 15th of each month.
A voided check or deposit slip must be included.

Bank Information (Depository)

Bank Name (Depository): _______________________________
Bank Address: _________________________________________
City/State: _____________________ ZIP Code: __________
Bank Routing Number: __________________________________

Employee Information

Employee Name (print): ________________________________
Date: ____________________
Employee Signature: ____________________________________

Checking Account Deposit Instructions

Checking Account Number: ______________________________

Select one option (Checking):

☐ Deposit entire check
☐ Specified amount per month: $__________ (List specified amount)
☐ Remainder of check

Savings Account Deposit Instructions

Savings Account Number: _______________________________

Select one option (Savings):

☐ Deposit entire check
☐ Specified amount per month: $__________ (List specified amount)
☐ Remainder of check

Notice About Changes

If you change any banking information, you must notify the Central Office Payroll Department immediately and complete a new Direct Deposit Authorization Agreement.

Missed Punch Request Form

Download: Missed Punch Request Form (PDF)

Missed Punch Request Form

Lebanon R-III School District

Employee Information

Employee Name: ________________________________

Date: ____________________
Job Title: _________________________________
Building: _________________________________

Missed Punch Details

Date of Missed Punch: __________________________

Type of Missed Punch

Select one option and include the time.

☐ Clock In: __________ a.m. / p.m.
☐ Lunch / Personal Out: __________ a.m. / p.m.
☐ Lunch / Personal In: __________ a.m. / p.m.
☐ Clock Out: __________ a.m. / p.m.

Reason for Missed Punch

Select one reason below:

☐ Forgot
☐ Computer Issues
☐ System Down
☐ Other: ________________________________________

Employee & Supervisor Signatures

Employee Signature: ____________________________

Date: ____________________
Supervisor Signature: __________________________
Date: ____________________

Office Use Only

Date Received: ____________________

Date Entered: _____________________
Entered By: _______________________

PSRS/PEERS Member Information Change Form

PSRS/PEERS Member Information Change Form (PDF)

PSRS/PEERS Member Information Change Form

Use this form to request a name change and/or address change on record with the Public School and Education Employee Retirement Systems of Missouri (PSRS/PEERS).

Important Information (Read First)

This form must be completed and returned to PSRS/PEERS. If you are changing your name:

Please print your full name. Do not use initials or nicknames.
Return the completed form and documentation providing proof of your name change, such as a copy of a marriage certificate, divorce decree, court order, driver's license or Social Security card.
Keep a copy of this form for your records.
PSRS/PEERS will acknowledge your name or address change once processed.

If you have questions, contact PSRS/PEERS at (800) 392-6848 or visit www.psrs-peers.org.

Required Documentation for Name Changes

If you are requesting a name change, you must:

Print your full legal name (do not use initials or nicknames)
Submit documentation showing proof of name change, such as:
- Marriage certificate
- Divorce decree
- Court order
- Driver’s license
- Social Security card

Section A: Member Information

Please complete all applicable fields.

First Name: ______________________________
Middle Name: ____________________________
Last Name: ______________________________
Member ID (or last four digits of Social Security Number): __________________
Telephone Number: ( ______ ) __________________
Email Address: ______________________________

Section B: Name Change Request

Use this section only if you are requesting a name change.

Change name from: ______________________________
Change name to: ________________________________
Effective Date of Change: _______________________

Signatures Required:

Original written signature as previously written: _______________________
Original written signature to be used in the future: _____________________
Date: ____________________

Section C: Address Change Request

Use this section only if you are requesting an address change.

Previous Mailing Address:

Street Address: ______________________________
City: ____________________
State: ___________________
ZIP Code: ________________

New Mailing Address:

Street Address: ______________________________
City: ____________________
State: ___________________
ZIP Code: ________________
Effective Date of Change: _____________________

Member Signature (original written signature required): _____________________
Date: ____________________

Where to Send This Form

Please submit the completed form and any required documentation to Dana Phillips at Central Office. The District will forward the materials to Public School and Education Employee Retirement Systems of Missouri (PSRS/PEERS) on your behalf.

PSRS/PEERS Mailing Address:
Public School and Education Employee Retirement Systems of Missouri
PO Box 268
Jefferson City, MO 65102-0268

PSRS/PEERS Contact Information:

Phone: (573) 634-5290 or (800) 392-6848
Fax: (573) 634-7934
Email: psrspeers@psrspeers.org
Website: www.psrs-peers.org

PSRS-PEERS Information Change Form

PSRS/PEERS Member Information Change Form

Use this form to request a name change and/or address change on record with the Public School and Education Employee Retirement Systems of Missouri (PSRS/PEERS).

Important Information (Read First)

This form must be completed and returned to PSRS/PEERS. If you are changing your name:

Please print your full name. Do not use initials or nicknames.
Return the completed form and documentation providing proof of your name change, such as a copy of a marriage certificate, divorce decree, court order, driver's license or Social Security card.
Keep a copy of this form for your records.
PSRS/PEERS will acknowledge your name or address change once processed.

If you have questions, contact PSRS/PEERS at (800) 392-6848 or visit www.psrs-peers.org.

Required Documentation for Name Changes

If you are requesting a name change, you must:

Print your full legal name (do not use initials or nicknames)
Submit documentation showing proof of name change, such as:
- Marriage certificate
- Divorce decree
- Court order
- Driver’s license
- Social Security card

Section A: Member Information

Please complete all applicable fields.

First Name: ______________________________
Middle Name: ____________________________
Last Name: ______________________________
Member ID (or last four digits of Social Security Number): __________________
Telephone Number: ( ______ ) __________________
Email Address: ______________________________

Section B: Name Change Request

Use this section only if you are requesting a name change.

Change name from: ______________________________
Change name to: ________________________________
Effective Date of Change: _______________________

Signatures Required:

Original written signature as previously written: _______________________
Original written signature to be used in the future: _____________________
Date: ____________________

Section C: Address Change Request

Use this section only if you are requesting an address change.

Previous Mailing Address:

Street Address: ______________________________
City: ____________________
State: ___________________
ZIP Code: ________________

New Mailing Address:

Street Address: ______________________________
City: ____________________
State: ___________________
ZIP Code: ________________
Effective Date of Change: _____________________

Member Signature (original written signature required): _____________________
Date: ____________________

Where to Send This Form

Please submit the completed form and any required documentation to Dana Phillips at Central Office. The District will forward the materials to Public School and Education Employee Retirement Systems of Missouri (PSRS/PEERS) on your behalf.

PSRS/PEERS Mailing Address:
Public School and Education Employee Retirement Systems of Missouri
PO Box 268
Jefferson City, MO 65102-0268

PSRS/PEERS Contact Information:

Phone: (573) 634-5290 or (800) 392-6848
Fax: (573) 634-7934
Email: psrspeers@psrspeers.org
Website: www.psrs-peers.org

PSRS-PEERS Unpaid Leave Information

PSRS/PEERS — Important Information About Unpaid Leave

Unpaid leave may affect your PSRS/PEERS service credit and retirement benefits. The information below explains how unpaid leave works, when service credit may be purchased, and what steps to take.

Missing work while on unpaid sick leave, workers' compensation leave or military leave means you may not earn a full year of service with PSRS/PEERS for the school year(s) in which the leave occurred. Additionally, the amount of unpaid salary will not be included in your total salary for the affected school year(s) which may impact the calculation of your benefits.

The good news is, you may be eligible to purchase service for time you were on leave from PSRS/PEERS-covered employment. You and your employer are required to pay contributions that would have been made had you been working during the period of leave. As the member, you can choose to pay your portion of the contributions due with personal funds or money rolled over from a qualified account. Please note, there are specific deadlines that apply to each type of purchase.

Unpaid Sick Leave and Workers' Compensation Leave

You may be able to purchase service for unpaid sick leave, if the leave is covered under your employer's sick leave policy or workers' compensation leave.
Your leave must have occurred during the current or previous two school years.
You pay to your employer the contributions you would have made to PSRS/PEERS on your full docked salary during the leave period.
Your employer sends both employee and employer contributions for the leave period to PSRS/PEERS.
Your membership is updated to reflect a full year of service, and your full amount of salary for the affected year(s).

Example: Unpaid Sick Leave Purchase

This example illustrates how costs may be calculated.

Unpaid salary during leave: $5,000
Employee contribution rate: 14.5%

Employee cost to purchase service credit:
$5,000 × 14.5% = $725

In some situations, unpaid maternity leave may also be purchased using the Basic Purchase Cost Calculation, which is based on:

Your highest annual salary on record
The combined employee and employer contribution rate
The amount of service credit being purchased

Example:

Highest annual salary: $50,000
Combined contribution rate: 29%
Service credit to purchase: 0.10000 year

Total purchase cost: $1,450
Cost examples are for illustration only. Actual costs may vary.

Leave for USERRA-Covered Military Service

USERRA-covered leave can be granted or purchased.

Granted USERRA-Covered Leave

Granted leave has no cost to you.
It counts toward vesting your membership and eligibility for benefits.
To receive granted USERRA leave, submit a copy of your DD214 to PSRS/PEERS.

Purchased USERRA-Covered Leave

There is a cost to purchase leave for USERRA-covered service.
Purchased service counts toward vesting and eligibility for benefits, and is also used in the calculation of your benefits.
You must return to the same employer and submit your DD214 within five years of your return to employment after the leave.
You pay the contributions you would have made to PSRS/PEERS on your full salary during the leave period.
Your employer also pays contributions. You can purchase up to five years of USERRA-covered service.

Reimbursement Forms

District Reimbursement

Download District Reimbursement Request

Reimbursement Request Form

Lebanon R-III School District

Use this form for non-professional development (NON-PD) reimbursement requests. This is a fillable PDF in the original version. If you are completing this online, please provide the same information below. Please state which department will reimburse the expense. If you are not sure, contact the individual who approved your expense.

Employee Information

Name: ______________________________________________
Building/Department: _________________________________
Reimbursement for (department): ________________________
Date of Request: ________________________________
Building Principal: ________________________________

Reimbursement Policies and Procedures

Meals

Meals will be reimbursed as follows:

Up to $30 per day, including sales tax and up to 20% gratuity. Gratuity must be written on the receipt.
Receipts must be itemized and may not include alcoholic beverages.
Reimbursements will not be issued if a receipt is not attached.
Meals will not be reimbursed when a meal is offered at a conference.

Mileage

Mileage will be reimbursed as follows:

$0.535 per mile, round trip, actual mileage

Reimbursement Breakdown (Meals)

List each day of meals below.

Entry 1

Date: ____________________
Breakfast Amount: $__________
Lunch Amount: $_____________
Dinner Amount: $____________
Daily Total: $______________

Entry 2

Date: ____________________
Breakfast Amount: $__________
Lunch Amount: $_____________
Dinner Amount: $____________
Daily Total: $______________

Entry 3

Date: ____________________
Breakfast Amount: $__________
Lunch Amount: $_____________
Dinner Amount: $____________
Daily Total: $______________

Total Meal Reimbursement: $________________________

Mileage Reimbursement

Total Roundtrip Miles: __________________
Mileage Rate: $0.535 per mile
Total Mileage Reimbursement: $________________________

Total Reimbursement

Total Reimbursement (Meals + Mileage): $________________________

Submission Instructions

Fill out the attached form, print, attach receipts, sign, and submit to your building principal or program director.

Signatures

Staff Signature: ____________________________________
Date: ____________________
Principal/Director Signature: _________________________
Date: ____________________

Mileage Reimbursement

Download Mileage Reimbursement Form

Mileage Report

Lebanon R-III School District

Submission Deadline: Mileage reports should be submitted to Central Office by the 25th of each month.

Employee Information

Employee Name: ________________________________

Reporting Month: ______________________________
School / Building: _____________________________

Mileage Log

Use the entries below to record each mileage activity for the month. Add additional entries as needed.

Entry 1

Date: ____________________
Activity / Purpose of Travel: ______________________________
Miles Traveled: ____________________

Entry 2

Date: ____________________
Activity / Purpose of Travel: ______________________________
Miles Traveled: ____________________

Entry 3

Date: ____________________
Activity / Purpose of Travel: ______________________________
Miles Traveled: ____________________

Monthly Mileage Total

Total Miles for the Month: __________________________

Submission Information

Submit the completed mileage report to Central Office.
Reports should be received no later than the 25th of each month.

Tuition Reimbursement

Download Tuition Reimbursement Form

Tuition Reimbursement Form

Lebanon R-III School District | 2025–2026

Please submit this completed form with a grade report or copy of your transcript to Human Resources at Central Office.

Submission Deadline: Final workday in August

Employee Information

Employee Name: ________________________________
Date: ____________________
Current Teaching Assignment: ______________________________
Current Building Assignment: ______________________________
Current Degree: ______________________________
Degree Pursuing: ______________________________
Institution Where Degree Is Being Obtained: ______________________________

Reimbursement Request Details

Number of credit hours requested for reimbursement: __________
- Maximum reimbursement is 6 credit hours per year
- Reimbursement rate is $75.00 per credit hour
- Payment for approved hours will be issued in October

Eligibility Guidelines

Credit hours will not be reimbursed after attainment of a Master’s degree unless the teacher is requested by Administration to get additional certification with documentation at Central Office to support.

Teachers are eligible to be reimbursed for up to six hours per year for hours appropriate to the following:

Pursuit of additional area(s) of certification
Coursework that enhances teaching skills
A planned Master's degree in education or in an area of certification. A copy of your Master's program that has been signed by your advisor must be on file in the Central Office if this area applies.
Teacher that has been requested by the school administration to obtain additional certification. Must have written approval from school administration attached to reimbursement form.

Certification and Signature

By signing below, I certify that the information provided reflects coursework taken within the previous school year.

Employee Signature: ________________________________
Date: ____________________

Submission Instructions

Submit the completed form and required documentation to:

Human Resources
Lebanon R-III School District
Central Office

Welcome to the Lebanon R-III School District Human Resources Department