"Application for Prior Exempt Service Credit Form" - Vermont

Application for Prior Exempt Service Credit Form is a legal document that was released by the Vermont Department of Human Resources - a government authority operating within Vermont.

Form Details:

  • Released on September 1, 2009;
  • The latest edition currently provided by the Vermont Department of Human Resources;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Vermont Department of Human Resources.

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Download "Application for Prior Exempt Service Credit Form" - Vermont

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Department of Human Resources
Print Form
HRIS
144 State Street
Montpelier, VT 05620-1701
APPLICATION FOR PRIOR EXEMPT SERVICE CREDIT FORM
An exempt employee who has either transferred into the classified service, or is rehired into the classified service within two (2)
years of separation from an exempt position, and who was not dismissed for cause, may be eligible for prior exempt service
credit in accordance with the terms of applicable collective bargaining agreement provisions. If found eligible, and upon
successful completion of any required original probationary period, the employee may receive an adjusted service date for
purposes of prospective leave accruals and reduction in force rights. This benefit is available to Non-Management, Supervisory,
State Police, and Corrections Bargaining Unit employees, as well as classified managerial and confidential employees.
EMPLOYMENT HISTORY
Employee’s Current Name:
Employee Number (5-digit ID):
Did you work previously under another name(s)? Please list all.
Employing Department:
Work Location:
Position Title:
Most Recent Date of Classified Service (month, day year):
List below any prior employment in an exempt State position with less than a two (2) year break in service. List most
recent exempt employment first. Attach additional sheets to document previous employment if necessary.
Employing Department:
Date of Hire:
Position Title:
Date of Separation or Transfer to Classified Service (month, day, year):
Performance Rating at least Satisfactory?
Yes
No
Were you dismissed for cause from this position?
Yes
No
Were you transferred to a classified position, or rehired into a classified position within two (2) years of separation from this
exempt position?
Yes
No
AGENCY/DEPARTMENT, HUMAN RESOURCE DIVISION REVIEW & APPROVAL
The above named employee has presented, and I have verified, satisfactory information to this agency/department that s/he is
eligible to receive classified prior service credit. This employee was rehired or transferred to a classified position within two (2)
years of separation from this exempt position and had a performance rating of at least satisfactory.
Date of receipt in Agency/Department, Human Resource Division
_________________________________________________
Signature of delegated HR representative authorizing credit
_________________________________________________
Date of receipt at the Department of Human Resources
_________________________________________________
Department of Human Resources adjusts Service Date for RIF and leave accrual to ____________________________________
DHR-Prior Exempt Service Credit Application Form (9/09)
Department of Human Resources
Print Form
HRIS
144 State Street
Montpelier, VT 05620-1701
APPLICATION FOR PRIOR EXEMPT SERVICE CREDIT FORM
An exempt employee who has either transferred into the classified service, or is rehired into the classified service within two (2)
years of separation from an exempt position, and who was not dismissed for cause, may be eligible for prior exempt service
credit in accordance with the terms of applicable collective bargaining agreement provisions. If found eligible, and upon
successful completion of any required original probationary period, the employee may receive an adjusted service date for
purposes of prospective leave accruals and reduction in force rights. This benefit is available to Non-Management, Supervisory,
State Police, and Corrections Bargaining Unit employees, as well as classified managerial and confidential employees.
EMPLOYMENT HISTORY
Employee’s Current Name:
Employee Number (5-digit ID):
Did you work previously under another name(s)? Please list all.
Employing Department:
Work Location:
Position Title:
Most Recent Date of Classified Service (month, day year):
List below any prior employment in an exempt State position with less than a two (2) year break in service. List most
recent exempt employment first. Attach additional sheets to document previous employment if necessary.
Employing Department:
Date of Hire:
Position Title:
Date of Separation or Transfer to Classified Service (month, day, year):
Performance Rating at least Satisfactory?
Yes
No
Were you dismissed for cause from this position?
Yes
No
Were you transferred to a classified position, or rehired into a classified position within two (2) years of separation from this
exempt position?
Yes
No
AGENCY/DEPARTMENT, HUMAN RESOURCE DIVISION REVIEW & APPROVAL
The above named employee has presented, and I have verified, satisfactory information to this agency/department that s/he is
eligible to receive classified prior service credit. This employee was rehired or transferred to a classified position within two (2)
years of separation from this exempt position and had a performance rating of at least satisfactory.
Date of receipt in Agency/Department, Human Resource Division
_________________________________________________
Signature of delegated HR representative authorizing credit
_________________________________________________
Date of receipt at the Department of Human Resources
_________________________________________________
Department of Human Resources adjusts Service Date for RIF and leave accrual to ____________________________________
DHR-Prior Exempt Service Credit Application Form (9/09)