mdcourts.gov Human Resources

HUMAN RESOURCES FORMS AND BROCHURES INDEX
Note: For WordPerfect versions, you must save to your computer before opening

Benefits/Retirement Professional Development/Educational Assistance

General Personnel Information Recruitment

Payroll/Leave (includes FMLA) Salary Administration

Performance Evaluation, Discipline, and Grievances Work/Life Balance

BENEFITS AND RETIREMENT

State of Maryland Judiciary-Benefits Provided

Health Benefits Forms for Current Benefit Year DBM Internet

Health Benefit Information (includes link to booklet) DBM Internet

State Retirement Agency: Member Forms SRPS Internet

State Retirement Agency: Benefits Handbooks SRPS Internet

Injured Employees/Jurors:
Accident Investigation Forms (Espanol) IWIF Internet Workers Comp Comm.
Authorization for Release of Medical Information IWIF Internet Workers Comp Comm.
First Report of Injury IWIF Internet Workers Comp Comm.
Temporary Prescription Card IWIF Internet Workers Comp Comm.

GENERAL PERSONNEL INFORMATION

Maryland Judiciary...And Justice for All

Employee Data/Emergency Contact Form (fillable pdf) Revised

Policy Acknowledgment

Disclaimer for At-Will Employment (Microsoft Word) (pdf)

Confidentiality Agreement (Internal Use Only)

Exit Interview Form (fillable pdf)

Reassignment Request (for use by Administrative Official)

Percent Change Request (for use by Administrative Official)

PAYROLL/LEAVE

Central Payroll Forms (W-4, W-5, Direct Deposit, Savings Bonds) Central Payroll Bureau

Timesheet (Fillable PDF File) (Instructions) (Conversion Table)

Overtime Authorization Log (Excel Spreadsheet)

Leave Request Slip (PDF File) (Fillable PDF File)

Application for Bereavement Leave (fillable pdf)

FMLA:

Certification of Health Care Provider for Employee's Serious Health Condition (http://www.dol.gov/esa/whd/forms/WH-380-E.pdf)
Certification of Health Care Provider for Family Member's Serious Health Condition (http://www.dol.gov/esa/whd/forms/WH-380-F.pdf)
Certification of Qualifying Exigency for Military Family Leave (http://www.dol.gov/esa/whd/forms/WH-384.pdf)
Certification for Serious Injury or Illness of Covered Servicemember-for Military Family Leave http://www.dol.gov/esa/whd/forms/WH-385.pdf)
Employee Rights and Responsiblities Under FMLA (http://www.dol.gov/esa/whd/fmla/finalrule/fmlaposter.pdf)
Period Reporting Form (in Microsoft Excel)

Judiciary Leave Donation and Leave Bank:
Policy on Leave Donations and the Judiciary Leave Bank
Judiciary Leave Bank Enrollment Form
Medical Certification/Request for Leave Form (fillable pdf)
Judiciary Leave Donation Form (fillable pdf)
Request for Reconsideration of Denial Form

PERFORMANCE EVALUATION, DISCIPLINE AND GRIEVANCE

Performance Evaluation Form (fillable pdf) (Word-landscape) (Word-portrait)

Appendix A (Exempt Positions): (fillable pdf) (Word-landscape)

Appendix B (Supervisory Positions): (fillable pdf) (Word-landscape)

Performance Evaluation Tip Sheet

Grievance and Appeal Form

Request for Review of Termination

PROFESSIONAL DEVELOPMENT/EDUCATIONAL ASSISTANCE

Application for Court Professional Certification Program - No longer accepting applications

Application for Court Supervisor/Manager Certification Program - Will be available January 2010

Lending Library Checkout Form (MS Word)

Application for Educational Assistance (Administration of the Educational Assistance Program)

Educational Assistance Reimbursement Form (Tuition Reimbursement Worksheet - MS Excel)

Course Registration Form (in pdf)

RECRUITMENT

Employment Requisition (in fillable pdf) (in Microsoft Word)

Employment Application (in fillable pdf) (in Microsoft Word)

Interview Questions/Notes Form (in pdf) (in Word)

Interview Log/Recruitment and Selection (in fillable pdf) (Word Perfect) For WordPerfect file, you must save to your computer before opening Revised

Authorization for Access to Records

Non-Competitive / Interchangeable Classifications FAQs

Opportunity for Reclassification Process FAQs

SALARY ADMINISTRATION

Designation of Employee to Function in an Acting Capacity (fillable pdf) Word Perfect For WordPerfect file, you must save to your computer before opening Revised

Position Description Questionnaire (fillable pdf) Word Perfect Microsoft Word For WordPerfect file, you must save to your computer before opening

Guidelines for Submitting Classification and Salary Actions

Request for Non-Competitive Reclassification/Interchangeable Actions (fillable pdf) Microsoft Word Revised

Recordation Clerk Transmittal Form (fillable pdf) Microsoft Word

Non-Competitive / Interchangeable Classifications FAQs

Opportunity for Reclassification Process FAQs

WORK/LIFE BALANCE

Alternate Work Schedule Request Form (fillable pdf)

Telework Agreement and Work Schedule

Telework Remote Site Self-Certification Checklist

Telework Work Plan

Employee Assistance Program Information

Employee Excellence Awards Program

Secondary Employment

ADR Volunteer Application

Benefits/Retirement	Professional Development/Educational Assistance
General Personnel Information	Recruitment
Payroll/Leave (includes FMLA)	Salary Administration
Performance Evaluation, Discipline, and Grievances	Work/Life Balance