"Application for Prior Classified Service Credit Form" - Vermont

Application for Prior Classified 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 Classified 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 CLASSIFIED SERVICE CREDIT FORM
A permanent-status classified employee (i.e., having successfully completed an original probationary period) who was not
dismissed for cause and who is rehired into a classified State position within two (2) years of separation from such prior
classified position, may receive an adjusted service date for purposes of prospective leave accruals and seniority for reduction
in force rights, if they meet the contractual eligibility requirements. 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 Hire into a Classified Service Position (month, day year):
List below any prior employment in a classified position(s) in which you successfully completed an original probationary
period, separated and were subsequently re-employed back into the classified position within two years. List last previous
employment first. Attach additional sheets to document previous employment if necessary.
Employing Department:
Date of Hire:
Position Title:
Date of Separation (month, day, year):
Did you successfully complete original probation in this position?
Yes
No
Have you returned to another classified position within two (2) years of separation from this position?
Yes
No
Were you dismissed for cause from this 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 into a classified position within two
(2) years of separation from a classified position(s) in which s/he successfully completed an original probationary period.
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 Classified Service Credit Application Form (9/09)
Department of Human Resources
Print Form
HRIS
144 State Street
Montpelier, VT 05620-1701
APPLICATION FOR PRIOR CLASSIFIED SERVICE CREDIT FORM
A permanent-status classified employee (i.e., having successfully completed an original probationary period) who was not
dismissed for cause and who is rehired into a classified State position within two (2) years of separation from such prior
classified position, may receive an adjusted service date for purposes of prospective leave accruals and seniority for reduction
in force rights, if they meet the contractual eligibility requirements. 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 Hire into a Classified Service Position (month, day year):
List below any prior employment in a classified position(s) in which you successfully completed an original probationary
period, separated and were subsequently re-employed back into the classified position within two years. List last previous
employment first. Attach additional sheets to document previous employment if necessary.
Employing Department:
Date of Hire:
Position Title:
Date of Separation (month, day, year):
Did you successfully complete original probation in this position?
Yes
No
Have you returned to another classified position within two (2) years of separation from this position?
Yes
No
Were you dismissed for cause from this 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 into a classified position within two
(2) years of separation from a classified position(s) in which s/he successfully completed an original probationary period.
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 Classified Service Credit Application Form (9/09)