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OFFICE OF HUMAN RESOURCES
             STANDARD FORMS  

Maryalnd Line

Janet S. Nugent, Director
 
Employment Services Above Base New Hire Registry
Temporary Employment Appeal and Grievance Temporary Staffing
Reclassification Leave Outside Compensation/ Employment
Acting Capacity Employers First Report of Injury

PEP

 Contractual  Employment (SPP)

Employment Services Forms

  

Description

File Name

Date Last Updated
DBM Hiring Freeze Exception Request Form hiring freeze Exc_req_fm.doc  Microsoft Word document

2/07
Request to Recruit Request to recruit.doc  Microsoft Word document

7/06
Request to Appoint requesttoappoint06.doc  Microsoft Word document

7/06
Contractual Conversion Cover Letter ContCover06.doc

7/06
Receipt of MS-22 recptms2.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.

8/02
recptms2.doc  Microsoft Word document
Equal Opportunity Applicant Data Form eooappldataform2007.doc  Microsoft Word document

7/07
Authority For Release Of Information Authority for release of inf.doc  Microsoft Word document

2/03
Reference Check Completion Form reference chk.doc  Microsoft Word document

3/03
Employee Disclosure of Criminal History CrimDisclose.doc  Microsoft Word document

3/03
State Application ms-100.doc  Microsoft Word document

8/02
ms-100.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
W4 Form and Completion Instructions 2008w4.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.

4/8/08
2008W4Instruction.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
IRMA Policy Acknowledgment Form IRMA-4518.doc  Microsoft Word document

7/29/03
IRMA-4518.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Acknowledgement of Policy on Sexual Harassment/Acknowlegement of Substance Abuse Policy acknosex&sub.doc  Microsoft Word document

2/05
acknosex&sub.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Sensitive Employees Classification Form sensitive_class.doc  Microsoft Word document

8/14/03
sensitive_class.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
DHMH 02.06.02 - Policy on Sexual Harassment DHMH Policy.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.

8/11/03
Receipt of State Personnel Policy - Domestic Violence And The Workplace domestic.doc  Microsoft Word document

8/08/02
domestic.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Driver Acknowledgment Form driverac.doc  Microsoft Word document

8/08/02
driverac.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Health Statement of Ability for Sedentary & Light Work hlthstat.doc  Microsoft Word document

8/08/02
hlthstat.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Employee Assistance Program Form eap.doc  Microsoft Word document

8/96
eap.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Leave of Absence Form leaveab2.doc  Microsoft Word document

5/12/03
leaveab2.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Release of Information ReleaseofInfo.doc Microsoft Word document

9/06
Sick Leave Counseling Form counsel.doc  Microsoft Word document

5/12/03
counsel.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Clearance Sheet clearance.doc  Microsoft Word document

9/07
clearance.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Supervisory Notification of Employee Separation separation_merit.doc  Microsoft Word document

2/05
separation_merit.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Appointment Certification Form ACF.doc  Microsoft Word document

10/22/02
ACF.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Position Selection Plan for Appointments Under Agency Delegated Approval (“PSP Lite”) PSP_lite.doc  Microsoft Word document

9/16/02
PSP_lite.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
PEP

PEP Management

excpepmanagement07.xls

8/07

PEP Non Supervisor

excpepnonsupervisor07.xls

8/07

PEP Supervisor

excpepsupervisor07.xls

8/07

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Above Base Hiring Forms

Documentation to Hire Above Base

AboveBaseForm.doc

10/07

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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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Position Reclassification Forms
Description

File Name

 Date Last Updated
Reclassification Request  (Documentation of Changes to position and selection procedures) 1854.doc  Microsoft Word document

8/08/02
1854.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Cover Memo for Reclassification Request cover.doc  Microsoft Word document

10/26/05
cover.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Position Description Form ms22.doc  Microsoft Word document

10/96
ms22.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
State Application ms-100.doc  Microsoft Word document

6/06/02
ms-100.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Instructions for Position Description Form ms22inst.doc  Microsoft Word document

10/96
ms22inst.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Supplemental Position Description Questionnaire - Secretarial questionnaire.doc  Microsoft Word document

5/07
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 Acting Capacity Forms

Description

 File Name

Date Last Updated
Request for Acting Capacity Form ms345-dbm.doc  Microsoft Word document

10/29/02
ms345-dbm.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
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Appeal & Grievance Forms

Description

 File Name

Date Last Updated
Appeal and Grievance Form (DBM-ERD-1) Grievance Form.doc  Microsoft Word document 12/02
Unsatisfactory Report of Service (MS106) ms106.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files. 5/98
Notice of Disciplinary Action (MS-4A) ms-4a.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files. 11/96
Notice of Termination (MS 507)

ms507.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.

05/98
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Leave Request Forms

Description

 File Name

Date Last Updated
Join The Leave Bank MS401.doc  Microsoft Word document 5/15/06
MS401.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Acknowledgement of Leave of Absence leave_a1.doc  Microsoft Word document 7/00
leave_a1.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Leave Bank Request Forms: MS408, Medical Request Form, Request For Leave Bank, Release of Medical Records) leave_b1.doc  Microsoft Word document 7/06
Donating Leave To Another Employee MS405.doc  Microsoft Word document 3/03
MS405.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
State Employee Leave Donation Program - Appeal Form MS 406.doc  Microsoft Word document 3/03
Memo To Employee Requesting Family Medical Leave (FMLA)

FMLA memo.doc  Microsoft Word document

 6/13/03
FMLA memo.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Completion Instructions - FMLA Forms Packet (FMLA) FMLA Packet.doc  Microsoft Word document 6/13/03
FMLA Packet.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
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  Microsoft Word document

 6/13/03

FMLA 410.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.

FMLA 412.doc  Microsoft Word document

FMLA 412.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.

FMLA 411.doc  Microsoft Word document
FMLA 411.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
FMLA 413.doc  Microsoft Word document
FMLA 413.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Request for Payment of Unused Annual Leave annualpayoutform.docMicrosoft Word document

2/07
Request for Release Time Authorization release_time.doc  Microsoft Word document

10/01/03
release_time.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.

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Work Related Injury Forms

Description

 File Name

Date Last Updated
Employers First Report of Injury (EFRI) for Employees: Instructions and Packet

efri.doc Microsoft Word document

9/15/07
efri.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
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Contractual Employment ( Special Payments Payroll) Forms

Description

 File Name

Date Last Updated
DBM Hiring Freeze Exception Request Form (New Contractual Employees) Hiring Freeze Exc req Fm.doc  Microsoft Word document 1/03
DHMH Personnel Services Administration SPP Hiring Guidelines spp3agd1.doc  Microsoft Word document 3/02
spp3agd1.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
DHMH Personnel Services Administration SPP Hiring Guidelines (Summary) spp3agd2.doc  Microsoft Word document 3/02
spp3agd2.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Special Payments Payroll Authorization

CPB311T_306.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.

4/06
Special Payments Payroll Authorization Form 312 312_form.doc   Microsoft Word document 3/2005
312_form.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
W4 Form and Completion Instructions 2008 w4.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.

4/8/08
2008W4Instruction.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Employee Withholding Allowance Worksheet for MD Employees Residing in Washington D.C.

2008 W4_Residents of DC.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.

3/27/06
Employee Withholding Allowance Certificate for MD Employees Residing in West Virginia 2008 W4 Residents of WV.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Payroll Direct Deposit Authorization

Direct Deposit.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.

3/2005
Contractual or Part-Time Employment Application 1242-1a.doc  Microsoft Word document 4/99
1242-1a.pdf  This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Contractual Employment Agreement 1242-2eff0703.doc Microsoft Word document 7/03
1242-2eff0703.pdf This is a PDF document. A download of Adobe Acrobat Reader is necessary to view PDF files.
Special Payments Payroll Employment Request 1242-6a.doc  Microsoft Word document 2/99