|
Employment Service
|
|
Description
|
File Name
|
Date Last Updated
|
|
DBM Hiring Freeze
Exception Request Form |
hiring
freeze Exc_req_fm.doc
|
2/07
|
|
Request to Recruit |
Request to recruit.doc |
7/09
|
|
Request to Appoint |
requesttoappoint06.doc
|
7/09
|
|
Contractual Conversion Cover Letter |
ContCover06.doc |
7/06
|
|
Receipt of MS-22 |
recptms2.pdf |
8/02
|
|
recptms2.doc |
|
Equal Opportunity
Applicant Data Form |
eooappldataform2007.doc |
7/07
|
|
Authority For
Release Of Information |
Authority for release of
inf.doc
|
2/03
|
|
Reference Check
Completion Form |
reference
chk.doc
|
3/03
|
|
Employee
Disclosure of Criminal History |
CrimDisclose.doc
|
4/09
|
|
State Application |
ms-100.doc
|
8/02
|
|
ms-100.pdf
|
|
W4 Form and
Completion Instructions |
2009w4.pdf
|
4/8/09
|
|
2009W4Instruction.pdf
|
|
IRMA Policy
Acknowledgment Form |
IRMA-4518.doc
|
7/29/03
|
|
IRMA-4518.pdf
|
|
Acknowledgement of Policy on Sexual Harassment/Acknowlegement
of Substance Abuse Policy |
acknosex&sub.doc |
2/05
|
|
acknosex&sub.pdf
|
|
Sensitive Employees Classification Form |
sensitive_class.doc |
8/14/03
|
|
sensitive_class.pdf |
|
DHMH 02.06.02 -
Policy on Sexual Harassment |
DHMH Policy.pdf
|
8/11/03
|
|
Receipt of State
Personnel Policy - Domestic Violence And The Workplace |
domestic.doc
|
8/08/02
|
|
domestic.pdf
|
|
Driver
Acknowledgment Form |
driverac.doc
|
8/08/02
|
|
driverac.pdf
|
|
Health Statement
of Ability for Sedentary & Light Work |
hlthstat.doc
|
8/08/02
|
|
hlthstat.pdf
|
|
Employee
Assistance Program Form |
eap.doc
|
7/09
|
|
Leave of Absence Form |
leaveab2.doc
|
5/12/03
|
|
leaveab2.pdf
|
|
Release of Information |
ReleaseofInfo.doc |
9/06
|
|
Sick Leave Counseling Form |
counsel.doc |
5/12/03
|
|
counsel.pdf |
|
Clearance Sheet |
clearance.doc
|
7/09
|
|
Supervisory Notification of Employee Separation |
separation_merit.doc
|
2/05
|
|
separation_merit.pdf |
|
Appointment Certification Form |
ACF.doc
|
10/22/02
|
|
ACF.pdf |
|
Position Selection Plan for Appointments Under Agency
Delegated Approval (“PSP Lite”) |
PSP_lite.doc |
9/16/02
|
|
PSP_lite.pdf |
|
PEP |
|
PEP Management
|
pepmanagement.xls
|
10/08
|
|
PEP Supervisor
|
pepsupervisor.xls
|
10/08
|
|
PEP Non Supervisor
|
pepnonsupervisor.xls
|
10/08
|
|
PEP
Statistical Data Collection Form
|
pepstatform.doc
|
10/08
|
|
PEP
Supervisor Feedback Form
|
pepsupfeedback.pdf
or
.doc
|
10/08
|
|
Behavioral
Elements Sample
|
behaviorelementssample.doc
|
10/08
|
|
Fair
Practice Statement
|
fair_practices_policy.doc
|
10/08
|
|
|
|
|
|
Return to Top of Page
|
|
Above Base Hiring
Forms |
|
Documentation to Hire Above Base
|
AboveBaseForm.doc
|
9/09
|
|
Request for Exception to Standard Salary |
ms27exception.doc |
9/09 |
|
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|
|
Temporary
Employment (TE) Forms |
|
Description |
File Name
|
Date Last Updated |
|
Request for TE
Employee Appointment |
TE Request
|
7/06
|
|
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to Top of Page |
|
Position
Reclassification Forms
|
|
Description |
File Name
|
Date Last Updated |
|
Request for Reclassification Postion |
MS-2024.doc |
7/01/09 |
|
Reclassification Position Questionairre |
MS-44.doc |
7/01/09 |
Reclassification
Request (Documentation of Changes to position and
selection procedures) |
1854.doc
|
7/01/09
|
|
1854.pdf |
|
Position
Description Form |
ms22.doc
|
10/96
|
|
ms22.pdf
|
|
State Application |
ms-100.doc
|
6/06/02
|
|
ms-100.pdf
|
|
Instructions for
Position Description Form |
ms22inst.doc
|
10/96
|
|
ms22inst.pdf |
|
Return
to Top of Page |
|
Acting
Capacity Forms
|
|
Description
|
File Name |
Date Last Updated
|
|
Request for Acting
Capacity Form |
Acting Capacity Form.xls
|
7/01/09 |
|
Return
to Top of Page |
|
Appeal & Grievance
Forms
|
|
Description
|
File Name |
Date Last Updated
|
|
Appeal and
Grievance Form (DBM-ERD-1) |
Grievance Form.doc
|
12/02 |
|
Unsatisfactory
Report of Service (MS106) |
ms106.pdf
|
5/98 |
|
Notice of
Disciplinary Action (MS-4A) |
ms-4a.pdf
|
11/96 |
|
Notice of
Termination (MS 507) |
ms507.pdf
|
05/98 |
|
Return
to Top of Page |
|
Leave
Request Forms
|
|
Description
|
File Name |
Date Last Updated
|
|
Join The Leave
Bank |
MS401.pdf
|
4/09 |
|
Acknowledgement of
Leave of Absence |
leave_a1.doc
|
7/00 |
|
leave_a1.pdf
|
|
Leave Bank Request
Forms: MS408, Medical Request Form, Request For Leave Bank,
Release of Medical Records) |
leave_b1.doc
|
7/06 |
|
Donating Leave To
Another Employee |
MS405.doc
|
3/03 |
|
MS405.pdf
|
|
State Employee
Leave Donation Program - Appeal Form |
MS 406.doc
|
3/03 |
|
Memo To Employee
Requesting Family Medical Leave (FMLA) |
FMLA memo.doc
|
6/13/03 |
|
FMLA memo.pdf
|
|
Completion
Instructions - FMLA Forms Packet (FMLA) |
FMLA Packet.doc
|
6/13/03 |
|
FMLA Packet.pdf
|
|
FMLA Packet Forms
Part 1: Employee
Information Form
Part 2: Response
Form for Employee Request for FMLA Leave Form
Part 3: FMLA
Certification of Health Care Provider Form
Part 4: Definition
of Serious Health Conditions
Part 5: Return To Work Medical Certification Form
|
FMLA 410.doc
|
6/13/03 |
|
FMLA 410.pdf
|
|
FMLA 412.doc
|
|
FMLA 412.pdf
|
|
FMLA 411.doc
|
|
FMLA 411.pdf
|
|
FMLA 413.doc
|
|
FMLA 413.pdf
|
|
Request For
Compressed Work Schedule
|
Memorandum
of Underdstanding.pdf |
08/26/08
|
|
Request for Payment of Unused
Annual Leave
|
annualpayoutform.doc |
2/07
|
|
Request for
Release Time Authorization |
release_time.doc
|
10/01/03
|
|
release_time.pdf
|
|
Leave Cards |
LeaveCards.doc |
6/09/09 |
|
Return to Top of Page
|
|
Telework
|
|
Telework
Agreement Forms |
telework
agreement forms.doc |
10/29/08
|
|
telework
agreement forms.pdf |
|
|
|
Return to Top of Page
|
|
Work
Related Injury Forms |
|
Description
|
File Name |
Date Last Updated
|
|
Employers First Report of Injury (EFRI) for Employees:
Instructions and Packet |
efri.doc
|
2/18/09
|
|
efri.pdf
|
|
Return
to Top of Page |
|
Contractual Employment
( Special Payments Payroll) Forms
|
|
**Interview Package** |
|
Description
|
File Name |
Date Last Updated
|
|
MS-22 Receipt Form |
ms22receiptform.doc |
3/09 |
|
Applicant Salary Request Letter |
applicantsalaryrequest.doc |
3/09 |
|
Authority for Release |
authforrelease.doc |
3/09 |
|
Criminal Conviction Form |
criminalconvictionform.doc |
3/09 |
|
Description
|
File Name |
Date Last Updated
|
|
DBM Hiring Freeze
Exception Request Form (New Contractual Employees) |
Hiring Freeze Exc req Fm.doc
|
1/03 |
|
DHMH Personnel
Services Administration SPP Hiring Guidelines |
spp3agd1.doc
|
3/02 |
|
spp3agd1.pdf
|
|
DHMH Personnel
Services Administration SPP Hiring Guidelines (Summary) |
spp3agd2.doc
|
3/02 |
|
spp3agd2.pdf
|
|
Special Payments
Payroll Authorization |
CPB311T.doc
|
4/06 |
|
Special Payments
Payroll Authorization Form 312 |
312_form.doc
|
3/2005 |
|
312_form.pdf
|
|
W4 Form and
Completion Instructions |
2009w4.pdf
|
4/8/09
|
|
2009W4Instruction.pdf
|
|
Employee
Withholding Allowance Worksheet for MD Employees Residing in
Washington D.C. |
2009 W4_Residents of DC.pdf
|
4/09 |
|
Employee
Withholding Allowance Certificate for MD Employees Residing in
West Virginia |
2009 W4 Residents of WV.pdf
|
|
Payroll Direct Deposit Authorization |
Direct Deposit.pdf
|
3/2005 |
|
Contractual or
Part-Time Employment Application |
1242-1a.doc |
4/99 |
|
1242-1a.pdf
|
|
Contractual
Employment Agreement |
1242-2eff0703.doc |
7/03 |
|
1242-2eff0703.pdf
|
|
Special Payments
Payroll Employment Request |
1242-6a.doc
|
2/99 |
|
1242-6a.pdf
|
|
Applicant and
Wages Form |
1819.doc
|
6/01/01 |
|
1819.pdf |
|
DHMH Contractual
Position Classification Worksheet |
PosClassWks.doc
|
8/09/02 |
|
State Application |
ms-100.doc
|
8/09/02 |
|
ms-100.pdf
|
|
Reference Check
Completion Form |
reference chk.doc
|
3/03 |
|
Education
Credentials Check Form |
edcreden.doc
|
3/97 |
|
edcreden.pdf
|
|
Education
Verification Form |
educveri.doc
|
8/02 |
|
educveri.pdf
|
|
Experience
Credentials Check Form |
expcrede.doc
|
3/97 |
|
expcrede.pdf
|
|
Experience
Verification Form |
expveri.doc
|
3/97 |
|
expveri.pdf
|
|
INS Employment
Eligibility Verification Form and Instructions |
I-9.pdf
|
4/09 |
|
Authority For
Release Of Information |
auth.doc
|
8/02 |
|
auth.pdf
|
|
Employee
Disclosure of Criminal History |
CrimDisclose.doc
|
3/03 |
|
IRMA Policy
Acknowledgment Form |
IRMA-4518.doc
|
7/29/03 |
|
IRMA-4518.pdf
|
|
State Substance
Abuse Policy Acknowledgment Form |
ack_rec_sub_abus.doc |
8/14/03 |
|
ack_rec_sub_abus.pdf
|
|
Sensitive Employees Classification Form |
sensitive_class.doc |
8/14/03 |
|
sensitive_class.pdf |
|
Rules For Use Of
State Vehicles/Driver Acknowledgment Form |
driverackn.doc
|
5/01/91 |
|
DHMH Sexual
Harassment Policy Acknowledgement Form |
sexhar acknowledgment.pdf
|
3/02 |
|
Health Benefits
Election Form |
hlthbene.doc
|
8/08/02 |
|
hlthbene.pdf
|
|
Receipt of State
Personnel Policy - Domestic Violence And The Workplace |
domestic.doc
|
8/08/02 |
|
domestic.pdf
|
|
Equal Opportunity
Applicant Data Form |
eeoappl306.doc
|
10/07/03 |
|
|
|
|
|
Request For State
ID Badge |
Id_replace.pdf
|
8/12/08 |
| Instructions
For Completing Special Payments Payroll Voucher |
PVOUCH2.pdf |
4/8/08 |
|
Special Payments
Payroll Voucher |
payvouch.doc
|
12/97 |
|
payvouch.pdf
|
Special
Payments Payroll -
Voucher Schedule |
2010SPPVoucherSchedule.doc |
6/09 |
| |
|
|
|
New Hire Check
List |
LISTA.doc
|
4/29/03 |
LISTA.pdf
 |
|
Renewal - Salary
Grade, Class or Function Change Check List |
LISTB.doc
|
6/02 |
|
LISTB.pdf
|
|
Renewal Check
List (B-1) |
LISTB-1.doc
|
4/29/03 |
|
LISTB-1.pdf
|
|
Renewal - No
Salary Grade, Class or Function Change Check List |
LISTC.doc
|
6/02 |
|
LISTC.pdf
|
|
Renewal Check
List (C-1) |
LISTC-1.doc
|
4/29/03 |
|
LISTC-1.pdf |
|
Health Benefits
Continuation Form |
hbcont.doc
|
6/06/02 |
|
hbcont.pdf
|
|
Authorization
Change Form |
311tauth.doc
|
4/98 |
|
311tauth.pdf
|
|
Change of Address
Form |
addchg.pdf
|
11/2001 |
|
Supervisory
Notification of Employee's Separation |
separat.doc
|
5/99 |
|
separat.pdf
|
|
Return
to Top of Page |
|
New
Hire Registry Form
|
|
File Name
|
Date Last Updated |
Description
|
|
Description
|
File Name |
Date Last Updated
|
|
New Hire
Registry Form
|
newhire.pdf
|
12/03/02
|
|
Return to Top of Page
|
|
Temporary Staffing
(Agency Help) Forms |
|
File Name
|
Date Last Updated |
Description
|
|
Description
|
File Name |
Date Last Updated
|
|
Procedures and
Request Form for Requesting Temporary Staffing |
Procedures For Requesting
Staffing.doc |
7/06 |
|
Listing of
Agency Help Classifications |
Agency Help Classes.doc |
7/01/05 |
|
Agency Help Classes.pdf |
|
Confidentiality
Statement for Temporary Staffing Vendor Employees |
Confidentiality Statement.doc |
1/03 |
| Temporary
Staffing Contract |
New_Rates.doc
|
12/07 |
|
New_Rates.pdf
|
|
Return to Top of Page
|
|
Disclosure of
Employment & Compensation Forms |
|
File Name
|
Date Last Updated |
Description
|
|
Description
|
File Name |
Date Last Updated
|
|
Disclosure of
Employment & Compensation Form Outside of DHMH |
secemp.doc
|
9/01
|
|
Return to Top of Page |
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