Forms

IMPORTANT FORMS 

Accidental death insurance coverage forms

Enroll now to receive up to $20,000 of our No Cost to You Accidental Death Insurance Coverage provided exclusively by Union Plus for one full year (the plan can be renewed at no cost yearly) No medical exam. No hassle. Click Here to Download Enrollment Form!

Family medical leave act (Fmla) 

The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Click here to learn more and download important forms!

Appeal and grievance form 

Do you believe you have a grievance or need to file an appeal? You can submit a request for an appeal and/or grievance by clicking here. You can upload a completed appeal and grievance form with your submission. Download the Form by clicking here!

Americans with disabilities act (ada) 

To be protected by the ADA, one must have a disability or have a relationship or association with an individual with a disability. An individual with a disability is defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment. Supervisors Click here if you are a Parole & Probation Agent to Download ADA Request Packet. ( Please note, any job classification can complete either packet. You just need to remove the job specific page from the packet).

Transfer of Service (Retirement systems)

Do you need to transfer your retriement from one system to another? You need to click here to complete a Form 37. Need other retirement forms? Click here to veiw the Forms Page directly on the State Retriement and Pensions System website. 

COVID-19 & VACCINE LEAVE REQUEST FORMS

Retroactive to January 1, 2024, through December 31, 2024, State/regular, temporary and contractual employees (prorated for part time) who test positive for COVID-19 will be eligible to use up to five days of paid COVID-19 Leave in place of an employee's own leave or leave without pay to recover from COVID-19. COVID-19 Leave must be used consecutively and in full-day increments, but is not required to be used all at one time.

 Employees who receive an Influenza vaccine or COVID-19 vaccination or booster may receive a maximum of two hours of vaccination leave within a one-year period for the purpose of obtaining the vaccine/booster to become fully vaccinated. 

 To receive COVID-19 Leave the following needs to be submitted to DPSCS HRSD Operational Support Unit:

 1)      COVID-19 Leave Request form 

2)      Photo (JPG, JPEG, any other viable format) of the positive ID test results

a.        If done at a practitioner: result to include Patient name, DOB, dated/timed collection and/or test result

b.       Self-Test or Over the Counter Test: test result placed on a piece of paper with name, DOB, date, and time written onto

To receive Vaccination Leave the following needs to be submitted to DPSCS HRSD Operational Support Unit:

 1)      Vaccine Leave Request form 

2)      Proof of the vaccine/booster (vaccination record, Immunization Information System print, Vaccine Information Statement, etc.)

These can be emailed to: [email protected]

 For faster processing, DPSCS employees can list in their email subject line, along with their name and institution, the following “OSU tag” (ex. John Doe, MTC, Baltimore OSU).