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Department of Human Capital Forms

Note: Some of the documents below require Adobe Acrobat Reader. Click here to download a free copy

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

BENEFITS
 Request for Transfer– Long-Term Absence
Office of Benefits Management
To formally document an alleged violation based on Race, Retaliation, Sex, Age, Religion, Disability, National Origin, and/or other reason.
To transfer employees to the 2025 organization.
Supporting medical and attendance documentation.
 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
 License Update Form
Certification Specialist
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 (207 KB) Office Human Capital – Business Unit, City Schools 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 (203 KB) Office Human Capital – Business Unit, City Schools 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 (237 KB) Office Human Capital – Business Unit, City Schools 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 (257 KB) Office Human Capital – Business Unit, City Schools 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
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GENERAL USE
 Personal Data Change/ Correction Form
Office of Position Management
To request a change in employee demographic information. Supporting documentation as indicated on the form
EMPLOYEE AND LABOR RELATIONS
 Equal Employment Opportunity Complaint Form
Office of Employee and Labor Relations
To formally document an alleged violation based on Race, Retaliation, Sex, Age, Religion, Disability, National Origin, and/or other reason.  
 Request For Reasonable Accommodation
Office of Employee and Labor Relations
To request an accommodation that you feel will enable you to effectively and safely perform the essential functions of your job. Needs to accompany the Self-Identification of Disabled Employee Status
 Self-Identification of Disabled Employee Status
Office of Employee and Labor Relations
To identify yourself as an employee with a disability. N/A
TUITION REIMBURSEMENT
* Tuition Reimbursement Policies and Procedures Office Human Capital – Business Unit Policies and procedures for tuition reimbursement Transcript, Grades, and Tuition Payments.
*  Tuition Reimbursement
Office Human Capital – Business Unit
To Gain approval for tuition reimbursement Transcript, Grades, and Tuition Payments.
BENEFITS
pdf image  Evidence of Insurability Form
Office of Benefits Management
Employees will need this form if they are jumping up more than 1 times their salary during open enrollment.  
 Affidavit For Employee Domestic Partnership Benefit
Office of Benefits Management
To enroll a same gender adult who can provide proof that partnership has been in existence for at least 6 months. A valid driver’s license, birth certificate and proof of address.
 Affidavit of Termination of Domestic Partnership
Office of Benefits Management
To terminate an Employee Domestic Partnership Benefit. N/A
 Disabled Dependent Waiver Request Form
Office of Benefits Management
To enroll a medically determined disabled dependent. The approval of disability is finalized by the health plan’s review board.  
 Benefits Election Form
Office of Benefits Management
To enroll or terminate benefits. Supporting documentation as applicable.
 Extended Sick Leave Request
Office of Benefits Management
Local 44 and CUB employees to apply for extended sick leave. Attendance records for the last 2 years and sick leave usage report
 Request For FMLA
Office of Benefits Management
To apply for request for FMLA Physician or Practitioner Certification form.
 Request For Leave Form
Office of Benefits Management
To apply for a leave of absence (sick, childcare, military, educational, family, etc.). If absence is for 30 days or more, it must be submitted to the Department of Human Capital for approval. Supporting documentation related to leave request.
 FMLA Information
Office of Benefits Management
FMLA Information N/A
 Employee Rights under FMLA
Office of Benefits Management
Employee Rights under FMA N/A
 Military Family Leave Notice
Office of Benefits Management
Military Family Leave Request N/A
 Sabbatical Leave Application Form
Office of Benefits Management
To apply for a Sabbatical Leave of Absence. Supporting documentation related to leave request.
 Verification of Economic Sole Support
Office of Benefits Management
To enroll a dependent other than a birth child (i.e. grandchild, minor sibling, or anyone for which you have guardianship). Proof of custody or guardianship and/or a copy of your Federal Income Tax Return
 Physician or Practitioner Certification Form
Office of Benefits Management
To verify reason for FMLA request Request for FMLA Form
NEW HIRE PROCESS
 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 (2009)
(Employee’s Federal Withholding Allowance Certificate)

Payroll Office
To claim the number of exemptions for Federal tax purposes. N/A
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Name
Where To Submit Form
Purpose of Form
Attachments Required
PAYROLL
""  Educational Services Approval Form
Payroll Office
To request approval for additional work beyond standard work hours and/or duties. N/A
 Educational Services Payment Order
Payroll Office
Once the Educational Services Approval Form has been completed and approved, and the employee has rendered services, the Manager/Principal submits this form by the Friday before pay day so that the employee can be paid. N/A
""  Payroll Direct Deposit
Payroll Office
To change direct deposit information. Voided Check
PDF  W2 Request Form
Payroll Office
To request W2 form.  


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