Form CT-HR-5 "Placement on Statewide Transfer List Request Form" - Connecticut

What Is Form CT-HR-5?

This is a legal form that was released by the Connecticut State Department of Administrative Services - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2011;
  • The latest edition provided by the Connecticut State Department of Administrative Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CT-HR-5 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Administrative Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form CT-HR-5 "Placement on Statewide Transfer List Request Form" - Connecticut

534 times
Rate (4.3 / 5) 27 votes
State of Connecticut
Placement On Statewide Transfer List Request Form
Form #: CT-HR-5
Revision Date: 9/2011
TO:
DAS – Statewide Human Resources Management –
– Hartford, CT 06103
ATTN: Vickey McCray (Fax# 860-622-2886 or e-mail Vickey.McCray@CT.GOV)
State employees may request to be placed on the statewide transfer list for their present job class if permanent status has been attained.
NOTE: Transfer lists are not maintained by DAS for any Clerical or Health Care Non-Professional bargaining unit positions
or for any unclassified positions.
Procedure: Eligible employee completes the “Employee” section of the form and checks desired location (s) on next page, and signs
the form to authorize their request for transfer. The employee then submits the form in its entirety to DAS-Statewide Human
Resources Management for review and processing. Once approved, the original request is retained in the DAS-Statewide Human
Resources Management files. An approved copy will be returned to the employee at the Home Address listed below.
IMPORTANT: Please check the
DAS Website - State Employment Page
to find out about and to apply for vacancies in State
agencies, universities and colleges. Indicate you are on the Statewide Transfer List when you submit your application material.
THIS SECTION IS TO BE COMPLETED BY THE EMPLOYEE
I request placement on the Statewide Transfer List.
Name:
___________________________________________________________________
Home Address:
___________________________________________________________________
___________________________________________________________________
Current Agency:
___________________________________________________________________
Phone Number during the day:
(_________) __________-______________ (include area code)
Social Security Number:
___________________________________________________________________
Employee ID Number:
___________________________________________________________________
Employee’s Class Title:
___________________________________________________________________
I am interested in transferring to the location (s) identified on Page Two of this form.
____________________________________
____________
Signature of Employee Requesting Transfer
Date
THIS SECTION FOR DAS-STATEWIDE HUMAN RESOURCES MANAGEMENT USE ONLY
Class code: _________________
Salary Group: ________________ Bargaining Unit: ___________________
In accordance with your request, your name has been added to the Statewide Transfer List for the following class:
________________________________________________________________________________________________________
Your name will remain on this list for a period of two years unless you request that it be removed or unless you have submitted
another request at the expiration of two years.
_____/_____/_____
_____/_____/_____
___________________________________________
______________
Effective Date
Expiration Date
DAS-Statewide HR Management Representative
Date
This form provided by the Department of Administrative Services
State of Connecticut
Placement On Statewide Transfer List Request Form
Form #: CT-HR-5
Revision Date: 9/2011
TO:
DAS – Statewide Human Resources Management –
– Hartford, CT 06103
ATTN: Vickey McCray (Fax# 860-622-2886 or e-mail Vickey.McCray@CT.GOV)
State employees may request to be placed on the statewide transfer list for their present job class if permanent status has been attained.
NOTE: Transfer lists are not maintained by DAS for any Clerical or Health Care Non-Professional bargaining unit positions
or for any unclassified positions.
Procedure: Eligible employee completes the “Employee” section of the form and checks desired location (s) on next page, and signs
the form to authorize their request for transfer. The employee then submits the form in its entirety to DAS-Statewide Human
Resources Management for review and processing. Once approved, the original request is retained in the DAS-Statewide Human
Resources Management files. An approved copy will be returned to the employee at the Home Address listed below.
IMPORTANT: Please check the
DAS Website - State Employment Page
to find out about and to apply for vacancies in State
agencies, universities and colleges. Indicate you are on the Statewide Transfer List when you submit your application material.
THIS SECTION IS TO BE COMPLETED BY THE EMPLOYEE
I request placement on the Statewide Transfer List.
Name:
___________________________________________________________________
Home Address:
___________________________________________________________________
___________________________________________________________________
Current Agency:
___________________________________________________________________
Phone Number during the day:
(_________) __________-______________ (include area code)
Social Security Number:
___________________________________________________________________
Employee ID Number:
___________________________________________________________________
Employee’s Class Title:
___________________________________________________________________
I am interested in transferring to the location (s) identified on Page Two of this form.
____________________________________
____________
Signature of Employee Requesting Transfer
Date
THIS SECTION FOR DAS-STATEWIDE HUMAN RESOURCES MANAGEMENT USE ONLY
Class code: _________________
Salary Group: ________________ Bargaining Unit: ___________________
In accordance with your request, your name has been added to the Statewide Transfer List for the following class:
________________________________________________________________________________________________________
Your name will remain on this list for a period of two years unless you request that it be removed or unless you have submitted
another request at the expiration of two years.
_____/_____/_____
_____/_____/_____
___________________________________________
______________
Effective Date
Expiration Date
DAS-Statewide HR Management Representative
Date
This form provided by the Department of Administrative Services
EMPLOYMENT DISTRICTS
Check the box(es) for ONLY the district(s) in which you will accept employment. Indicate your choice of location preference(s) in the left hand
column by checking the appropriate box (es) where you are willing to work. Not all jobs are used in all locations. Names will be certified by
location only at the request of the appointing authority. Location preferences may be changed by submitting a written request to DAS-Statewide
Human Resources Management.
A
All Locations
B
Greenwich, Stamford, New Canaan, Darien
C
Norwalk, Wilton, Weston, Westport
D
Fairfield, Easton, Monroe, Trumbull, Shelton, Stratford, Milford
E
Bridgeport
F
Redding, Ridgefield, Danbury, Bethel, Newton, Brookfield, New Fairfield, Bridgewater, Sherman, New Milford
Roxbury, Washington, Kent, Warren
G
Morris, Litchfield, Harwinton, New Hartford, Torrington, Goshen, Cornwall, Sharon, Salisbury, Canaan,
North Canaan, Norfolk, Colebrook, Winchester, Hartland, Barkhamsted
H
Thomaston, Bethlehem, Watertown, Woodbury, Southbury, Middlebury, Beacon Falls, Naugatuck, Prospect,
Waterbury, Wolcott, Cheshire
I
Oxford, Seymour, Ansonia, Derby
J
West Haven, Orange, Woodbridge, Bethany, Hamden, North Haven, East Haven, North Branford, Wallingford, Branford, Guilford,
Madison, Clinton
K
New Haven
L
Meriden
M
Plymouth, Bristol, Burlington
N
Berlin, Southington, Plainville, New Britain
O
Avon, Farmington, West Hartford
P
East Hartford, Manchester
Q
Hartford
R
Granby, Canton, Simsbury, Suffield, East Granby, Windsor Locks, Windsor, Bloomfield, East Windsor
South Windsor Ellington, Vernon, Tolland, Stafford, Willington
S
Enfield, Somers
T
Newington, Wethersfield, Rocky Hill
U
Union, Ashford, Mansfield, Chaplin, Hampton, Windham, Scotland, Lebanon
V
Cromwell, Portland, Middletown, Middlefield, Durham, East Hampton, Haddam, East Haddam, Chester, Essex,
Killingworth, Deep River, Westbrook, Old Saybrook
W
Lyme, Old Lyme, East Lyme, Salem, Montville, Waterford, New London, Ledyard, Groton, Stonington North Stonington
X
Bozrah, Franklin, Norwich, Sprague, Lisbon, Preston, Griswold, Voluntown
Y
Woodstock, Thompson, Putnam, Pomfret, Eastford, Brooklyn, Canterbury, Plainfield, Sterling, Killingly
Z
Glastonbury, Marlborough, Colchester, Hebron, Columbia, Andover, Bolton, Coventry
This form provided by the Department of Administrative Services
Page of 2