Health Benefit Forms
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Enrollment Form-Active & Satellite Employee July 2011 - June 2012
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Enrollment Form-Direct Pay July 2011 - June 2012
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Enrollment form Retirees July 2011 - June 2012
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Affidavit
for Spousal Eligibility and Tax Status |
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Affidavit of
Status for all Dependent Children
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Dependent Child
Documentation |
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Affidavit for Domestic Partnership and Domestic Partner's Dependents |
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Disabled Dependent Certification Form
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HIPPA Authorization Form
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Mail Order Prescription Form
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Met Life Life Insurance Beneficiary Designation Form
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Met Life AD & D Plan Beneficiary Designation Form
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Met
Life Statement of Health Form
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Employee
Assistance Program |
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Employee Assistance Program |
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Confidential EAP Supervisory Referral Form |
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Employee Safety & Risk Management Forms |
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Employee's Claim Form C-1 - Workers' Compensation Commission
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IWIF Accident Leave Request Form
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Accident
Leave Policy
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Emergency Contact Form (optional)
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Temporary Prescription Services ID Important Benefit Information
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Crosswalk Incident Report |
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Accident
Follow-up Report |
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First Report of Injury or Illness |
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Employee Report of Injury
(English) |
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Employee Report of Injury
(Spanish) |
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Workplace Potential Hazard Report |
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Ergonomic
Assessment Request Form |
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State of Maryland Domestic Violence Policy |
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Accommodations for Persons With Disabilities Forms |
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Voluntary Request for Reasonable Accommodation |
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Telework & Compressed Work Week Forms
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State
of Maryland Telework Policy |
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Maryland Telework Agreement and Telework
Acknowledgement Form |
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Telework Schedule |
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Telework Work Plan
and the Weekly Assignments and Hourly Work Log |
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Telework Eligibility Checklist
Form
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Department of Natural Resources Compressed Work Week Agreement
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Financial Disclosure Forms |
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Receipt of Disclosure Forms
More info at http://ethics.gov.state.md.us/ |
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Training Forms |
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Application For Out Service Training Authorization
- 551 form |
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Career Development Plan |
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Tuition Reimbursement - OS2 |
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Acting Capacity Forms |
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Designation Of Employee To Function In An Acting Capacity - MS 345
New |
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Grievance & Disciplinary |
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Individuals Delegated to Act on Behalf of the Appointing Authority
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Mediation
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Notice of Disciplinary Action
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Disciplinary Guidance |
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State Personnel Management System Appeal and Grievance Form
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Change in Bargaining Status |
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Managerial Employee Affidavit |
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Supervisory Employee Affidavit |
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Confidential Employee Affidavit |
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Performance Planning and Evaluation Program |
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Revised PEP Forms: Skilled and Professional Positions
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Guidelines & Instructions |
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Management Employees (Exec) |
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Non-Supervisory Employees (Exec) |
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Supervisory Employees (Exec) |
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Performance Improvement Plan |
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Supervisor Feedback Instrument |
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Template for Mid-Cycle Memo |
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Staffing, Recruitment and Cutoff Forms |
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Cut-Off Form for Separations
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State of Maryland Performance Planning and Evaluation Program
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Probationary Evaluation Form
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Hiring Appointment Package |
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New Hire
Appointment Package Check-off Form |
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Memo to
Vacant Position Revised Form
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Interview Form |
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DBM Hiring Freeze Exemption Request (HFE) |
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Reference Check Form |
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Verification of Qualifications Form |
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DNR 1 Transaction Form |
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Maryland New Hire Registry |
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Offer of Employment Letter |