Form CT-HR-12 "Dmhas Lateral Transfer Request Form" - Connecticut

What Is Form CT-HR-12?

This is a legal form that was released by the Connecticut Department of Mental Health & Addiction 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 July 23, 2012;
  • The latest edition provided by the Connecticut Department of Mental Health & Addiction 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 printable version of Form CT-HR-12 by clicking the link below or browse more documents and templates provided by the Connecticut Department of Mental Health & Addiction Services.

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Download Form CT-HR-12 "Dmhas Lateral Transfer Request Form" - Connecticut

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DMHAS Postings, Employment Application and this form can be found on
the DMHAS website at: www.ct.gov/dmhas/employmentopportunities
DMHAS Lateral Transfer Request Form
**PLEASE SUBMIT TO THE FACILITY LISTED ON JOB POSTING**
This form should be used ONLY
BY DMHAS employees seeking a lateral transfer
(DMHAS employee’s
MUST BE SAME
as classification
current
title
/title posted) within DMHAS
OR:
DMHAS employees who are promotional candidates must submit pages 1-7 of the State of Connecticut Application for
Examination and Employment (CT-HR-12). The position number must be noted at the bottom of Page One of the State of
.
Connecticut Application (CT-HR-12)
Individuals not employed by DMHAS who are seeking consideration for an employment opportunity at DMHAS must complete, in
its entirety, a State Employment Application for Examination and Employment (CT-HR-12). Resumes and Curriculum Vitae can be
.
provided as supplemental information but will only be accepted if attached to a fully completed application
I am applying to the following lateral transfer opportunity:
DMHAS Employment Services -
Position Apply for/Classification:
Position Number
Facility
Shift/Schedule/Rotation
Division/Unit
Within the last twelve (12) months, have you accepted a lateral transfer that changed your shift or location?
yes
no If yes,
describe the transfer:
Detailed on the posting are special requirements for this position. I have the following special requirements : _______________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
bilingual – Languages:
Name
Employee #
Street Address
Town
Zip Code
Work Telephone # (include area code)
Home Telephone # (include area code)
Cell # (include area code)
Present Facility
Division/Unit
Present State Job Title
Present Shift
Present Hours (e.g.35,37.5,40)
Name Immediate Supervisor
Telephone # (include area code)
I certify that the statements made by me on this form are true and complete to the best of my knowledge and are made in good faith.
Employee Signature
Date
Employment Services USE ONLY
Seniority:
/
/
As of: ______________
Representative Initials
Yrs
Mos. Days
SS#: _______________________
W:\Employment Services Division\Recruit Select Place checklist and procedure\DMHAS EMPLOY LatTrnsForm\DMHAS lateral transfer form 7-23-12
.doc
revised 7-23-12
(standard)
DMHAS Postings, Employment Application and this form can be found on
the DMHAS website at: www.ct.gov/dmhas/employmentopportunities
DMHAS Lateral Transfer Request Form
**PLEASE SUBMIT TO THE FACILITY LISTED ON JOB POSTING**
This form should be used ONLY
BY DMHAS employees seeking a lateral transfer
(DMHAS employee’s
MUST BE SAME
as classification
current
title
/title posted) within DMHAS
OR:
DMHAS employees who are promotional candidates must submit pages 1-7 of the State of Connecticut Application for
Examination and Employment (CT-HR-12). The position number must be noted at the bottom of Page One of the State of
.
Connecticut Application (CT-HR-12)
Individuals not employed by DMHAS who are seeking consideration for an employment opportunity at DMHAS must complete, in
its entirety, a State Employment Application for Examination and Employment (CT-HR-12). Resumes and Curriculum Vitae can be
.
provided as supplemental information but will only be accepted if attached to a fully completed application
I am applying to the following lateral transfer opportunity:
DMHAS Employment Services -
Position Apply for/Classification:
Position Number
Facility
Shift/Schedule/Rotation
Division/Unit
Within the last twelve (12) months, have you accepted a lateral transfer that changed your shift or location?
yes
no If yes,
describe the transfer:
Detailed on the posting are special requirements for this position. I have the following special requirements : _______________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
bilingual – Languages:
Name
Employee #
Street Address
Town
Zip Code
Work Telephone # (include area code)
Home Telephone # (include area code)
Cell # (include area code)
Present Facility
Division/Unit
Present State Job Title
Present Shift
Present Hours (e.g.35,37.5,40)
Name Immediate Supervisor
Telephone # (include area code)
I certify that the statements made by me on this form are true and complete to the best of my knowledge and are made in good faith.
Employee Signature
Date
Employment Services USE ONLY
Seniority:
/
/
As of: ______________
Representative Initials
Yrs
Mos. Days
SS#: _______________________
W:\Employment Services Division\Recruit Select Place checklist and procedure\DMHAS EMPLOY LatTrnsForm\DMHAS lateral transfer form 7-23-12
.doc
revised 7-23-12
(standard)