• Office of Human Capital Forms

    Updated January 11, 2017

    Name

    Where To Submit Form

    Purpose of Form

    Attachments Required

    GENERAL USE

    Resignation Statement

    Principal or Manager and Human Capital Specialist

    To officially notify City Schools that you are resigning from Baltimore City Public Schools

    N/A

    Verification of Employment

    Office Human Capital – Records

    For verification that an employee currently or previously worked for the district; position(s) and time frame; where the assignment(s) were located; salary. N/A
    Personal Data Change/Request Form

    Human Capital Information Systems

    To request a change in employee demographic information.

    Supporting documentation as indicated on the form

    Employee Incident Report

    City of Baltimore Occupational Medical Services (Mercy Clinic) at 323
    N. Calvert Street with City Schools ID

    To report any work-related incident on the job

    N/A

    CERTIFICATION       | Top |

    License Update Form

    Office Human Capital – Certification

    To update an employee’s license information prior to the license expiration date.

    Copy of updated license

    Highly Objective State Standards of Evaluation (HOUSSE) forms

    For middle, secondary, and pre-K-12 (Art & Music) teachers

    Office Human Capital – Certification

    Obtain Highly Qualified (HQ) status using HOUSSE. HOUSSE is only available to professionally certificated teachers hired prior to the first day of the 2002-2003 school year. Information on NCLB and requirements for new teachers is available in the certification and NCLB areas on the MSDE website, www.marylandpublicschools.org

    None

    For early childhood or elementary teachers working in elementary schools

    Office Human Capital – Certification

    Obtain Highly Qualified (HQ) status using HOUSSE. HOUSSE is only available to professionally certificated teachers hired prior to the first day of the 2002-2003 school year. Information on NCLB and requirements for new teachers is available in the certification and NCLB areas on the MSDE website, www.marylandpublicschools.org

    None

    For middle and secondary special education teachers

    Office Human Capital – Certification

    Obtain Highly Qualified (HQ) status using HOUSSE. HOUSSE is only available to professionally certificated teachers hired prior to the first day of the 2002-2003 school year. Information on NCLB and requirements for new teachers is available in the certification and NCLB areas on the MSDE website, www.marylandpublicschools.org

    None

    For early childhood, elementary, and Alt-MSA assignments

    Office Human Capital -- Certification

    Obtain Highly Qualified (HQ) status using HOUSSE. HOUSSE is only available to professionally certificated teachers hired prior to the first day of the 2002-2003 school year. Information on NCLB and requirements for new teachers is available in the certification and NCLB areas on the MSDE website, www.marylandpublicschools.org

    None

    TUITION REIMBURSEMENT

    Tuition Reimbursement Policies and Procedures

    Office of Human Capital -Tuition Reimbursement

    Policies and procedures for tuition reimbursement

    Transcript, Grades, and Tuition Payments.

    Tuition Reimbursement

    Office of Human Capital - Tuition Reimbursement

    To gain approval for tuition reimbursement

    Transcript, Grades, and Tuition Payments.

    BENEFITS (Health & Welfare)     | Top |

    Benefits Election Form

    Office Human Capital – Benefits

    To enroll or terminate benefits.

    Supporting documentation as applicable.

    Disabled Dependent Waiver Request Form

    Office Human Capital – Benefits

    To enroll a medically determined disabled dependent. The approval of disability is finalized by the health plan’s review board.

    BENEFITS (Leaves)          | Top |

    Request For Personal Leave Form

    Office Human Capital – Benefits

    If absence is for 5 days or more, it must be submitted to the Office of Human Capital for approval. Supporting documentation related to leave request.
    Educational Leave Form

    Office Human Capital – Benefits

    Any Paraprofessional who is engaged in an educational program and who may need a leave of absence for student teaching or other reasons to complete requirements for graduation shall be granted such leave with pay, and shall be assured a reassignment to his former position or one comparable at the end of such leave. Paraprofessionals on educational leave for the purpose of student teaching or matriculating in an institution of higher education shall have health care benefits continued by the Board Educational Study Required Documents:
    1. Official Letter of Acceptance from the College or University Registrar’s office denoting per semester class load hours and a list of courses to be completed (copies not acceptable)

    2. At the end of each semester, official documentation from Registrars’ office denoting course(s) completion MUST be submitted within 14 days of semesters ending to the Office of Leaves Management, failure to do so WILL terminate your Educational Leave Status.

    3. Area of Study Must be directly related to your employment status

    4. Student Teaching Required Documents:
    Official Letter of Acceptance from the College or University Registrar’s office outlining Student Teaching assignment.
    Unpaid Childcare Leave Form

    Office Human Capital – Benefits

    An employee, at their request, may be granted a leave of absence without pay for the purpose of child-bearing or child-rearing for such period of time they specify, but not to exceed ONE (1) year Original Hospital Verification of Birth (copies unacceptable) or
    A Copy of Original Birth Certificate MUST accompany request.
    Sick Leave of Absence Form (Non-FMLA)

    Office Human Capital – Benefits

    This Sick Leave form is NOT INTENDED to be used for any leave that qualifies for or that is designated as Family Medical Leave (FMLA).

    This form is intended for use to substantiate the need for use of SICK LEAVE due to employees own medical condition of greater than 5 days when FMLA has been exhausted or employee does not qualify for FMLA.
    Certification Health Care Provider Form – Non FMLA Sick Leave

    FMLA Request Approval Packet - Family Member

    Office Human Capital – Benefits

    To apply for request for FMLA (family member)

    Physician or Practitioner Certification form.

    FMLA Request Approval Packet - Self

    Office Human Capital – Benefits

    To apply for request for FMLA (self)

    Physician or Practitioner Certification form.

    FMLA Request Approval Packet - Self and Family Member

    Office Human Capital – Benefits

    To apply for request for FMLA - Employee and family member needs.

    Physician or Practitioner Certification form.

    Employee Rights under FMLA

    Office Human Capital – Benefits

    Employee Rights under FMLA

    N/A

    FMLA Employee Process at a Glance | FMLA Employee Process in Detail Office Human Capital – Benefits This flowchart provides general information to walk you through your initial request for FMLA N/A

    Military Family Leave of Absence Form

    Office Human Capital – Benefits

    Military Family Leave Request

    N/A

    Sabbatical Leave Application Form

    Office Human Capital – Benefits

    To apply for a Sabbatical Leave of Absence.

    Supporting documentation related to leave request.

    NEW HIRE PROCESS         | Top |

    Form MW507 (Employee’s Maryland Withholding Exemption Certificate)

    Payroll Office

    To claim Maryland Tax Exemptions or to exclude deduction of Maryland income tax for employees who work in Maryland but reside in another state.

    N/A

    Form W-4 (2011) (Employee’s Federal Withholding Allowance Certificate)

    Payroll Office

    To claim the number of exemptions for Federal tax purposes.

    N/A

    |

    PAYROLL | Top |
    Pennsylvania State Tax Withholding Election Form

    Payroll Office   

    To claim Pennsylvania Tax Exemptions    

     N/A

    Payroll Direct Deposit

    Payroll Office

    To change direct deposit information.

    Voided Check

    W2 Request Form

    Payroll Office

    To request W2 form.