Form CT-HR-28 "Request to Hold Classified Position in Accordance With C.g.s. Section 5-248(F)" - Connecticut

What Is Form CT-HR-28?

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 June 7, 2016;
  • 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-28 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Administrative Services.

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Download Form CT-HR-28 "Request to Hold Classified Position in Accordance With C.g.s. Section 5-248(F)" - Connecticut

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State of Connecticut Human Resources
Request to Hold Classified Position in Accordance with C.G.S. Section 5-248(f)
Form #: CT-HR-28
Revision Date: 06/07/2016
Background: CGS Section 5-248(f) as amended by Public Act 13-247 states: “A classified employee with at
least five years of state service appointed to an unclassified position may be granted a leave of absence without
pay from the classified service by the Commissioner of Administrative Services for such length of time as he or
she shall hold such appointive position, except that no such leave of absence shall exceed two consecutive
years unless such classified employee requests and is granted a renewal of such leave of absence by the
commissioner.
Section 1: To be completed by the employee
Check One:
Original Request: _____
Request for Extension: _____
Employee Name: ____________________________________ Employee ID: _________
Current Classified Official Job Title: ________________________________________
Agency: _____________________________________________________________
Unclassified Official Job Title: ____________________________________________
Agency: _____________________________________________________________
Date of appointment to the unclassified service: ______________________________
In accordance with CGS Section 5-248(f), I am requesting an unpaid leave of absence from my current classified
position to serve in a position in the unclassified service.
I understand:
I must have at least 5 years of state service to make this request.
The approval of this request is at the discretion of my agency head and the Commissioner of
Administrative Services.
If approved, the leave of absence will be for a maximum of two years, unless I request and am granted
an extension.
If my unclassified position or agency changes, a new request must be made.
If the agency where my position is held merged into another agency, a new request must be made.
Any extension must be requested in writing and approved by my agency head and the Commissioner of
Administrative Services.
Signature: ____________________________________________ Date: _______________
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State of Connecticut Human Resources
Request to Hold Classified Position in Accordance with C.G.S. Section 5-248(f)
Form #: CT-HR-28
Revision Date: 06/07/2016
Background: CGS Section 5-248(f) as amended by Public Act 13-247 states: “A classified employee with at
least five years of state service appointed to an unclassified position may be granted a leave of absence without
pay from the classified service by the Commissioner of Administrative Services for such length of time as he or
she shall hold such appointive position, except that no such leave of absence shall exceed two consecutive
years unless such classified employee requests and is granted a renewal of such leave of absence by the
commissioner.
Section 1: To be completed by the employee
Check One:
Original Request: _____
Request for Extension: _____
Employee Name: ____________________________________ Employee ID: _________
Current Classified Official Job Title: ________________________________________
Agency: _____________________________________________________________
Unclassified Official Job Title: ____________________________________________
Agency: _____________________________________________________________
Date of appointment to the unclassified service: ______________________________
In accordance with CGS Section 5-248(f), I am requesting an unpaid leave of absence from my current classified
position to serve in a position in the unclassified service.
I understand:
I must have at least 5 years of state service to make this request.
The approval of this request is at the discretion of my agency head and the Commissioner of
Administrative Services.
If approved, the leave of absence will be for a maximum of two years, unless I request and am granted
an extension.
If my unclassified position or agency changes, a new request must be made.
If the agency where my position is held merged into another agency, a new request must be made.
Any extension must be requested in writing and approved by my agency head and the Commissioner of
Administrative Services.
Signature: ____________________________________________ Date: _______________
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Employee Name: ________________________ Employee ID: __________ Agency: __________________
Section 2: To be completed by the Agency Head or HR Administrator
To be completed by Agency
HR Administrator or
Designee:
I have reviewed the request for a leave of absence from the classified service
and have considered the ramifications for my agency and:
Position # of Held Position:
______________________
I approve the above request ____
If approved, indicate: start date ___/__/____ end date___/__/___
I deny the above request ____
Signature: ____________________________________________ Date: _______________
Agency Head or HR Administrator
Section 3: To be completed by the DAS Commissioner or Designee
I have reviewed the request for a leave of absence from the classified service and have considered the
ramifications for the state and:
I approve the above request ____ If approved, indicate: start date ___/__/____ end date___/__/___
I deny the above request ____
Signature: ____________________________________________ Date: _______________
DAS Commissioner or Designee
Notes:
1. Requests can be approved for a maximum of two (2) years.
2. The request is sent to DAS if approved by the agency head. (Completed forms can be emailed to
Nicholas.Hermes@ct.gov or faxed to 860-730-8438.)
3. A copy of this form, if approved by the agency head and the DAS Commissioner (or designee), should be
given to the employee and a copy kept in the employee’s personnel file. If a leave of absence is approved,
it must be reflected in CORE-CT with the approved Expected Return Date.
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