DHR Forms and Personnel Memoranda

Personnel Memoranda: 

Click to view  Personnel Memoranda. 

On-Boarding:

Conditional Offer of Employment Medical Form

WEP Request Form

Chapter 68: Conflict of Interest Form

Pamphlet COIB-DOE

OP-4444 - Employment Relationship with Family

Disclosure of Misconduct Form

Rules and Regulations Governing Administrative Employees

Mantoux Test Form (TB Test)

Free TB Test Centers

Pre-Employment Background Checks:

OSPRA 103
When submitting the OSPRA 103, the Fingerprint Referral Form and I-9 Form are also required, including a clear copy of each acceptable document that is used to show eligibility to work in the United States. Please note: Once the OSPRA 103 has been submitted and entered, additional fingerprinting at 65 Court Street for the person who submitted the OSPRA 103 is prohibited.

OSPRA 104

Mantoux Test Form

Free TB Test Centers

Fingerprint Referral Form

Employment Eligibility Verification (I-9) form

Personal and Tax Data Changes:

Personal and Tax Data Change form
The Personal and Tax Data Change form replaces the formerly used OP-85 form. Make sure to use this form to make any necessary tax and data changes.

W4

IT-2104

IT-2104E

Withholding Certificate Affirmation

Payroll and Direct Deposit:

New York City Office of Payroll Administration

Visit the Division of Financial Operations' Direct Deposit Web page for more information.

Salary Services:

Salary Upgrade Form for Educational (UFT) and Family (DC37) Paras

Salary Step Application (Teachers and School Professionals)

Commencement of Service Form

Restoration Form

Reversion Form

Employment Verification:

Employment Verification Request Form

Employment Records Research Request Form

Archived W-2 Data Request Form

Visit the employment verification Web page for more information about the use of these forms.

Health Benefits:

For details about choosing a health benefits carrier and plan, please visit the Health Benefits page.

ERB Health Benefits Application

Health Benefits Report Inquiry

Medical Spending Conversion Form (Plan Year 2009)

Medical Spending Conversion Form (Plan Year 2010)

COBRA Continuation of Coverage for Healthcare Application (and rates)
For more information, visit http://www.dol.gov/.

Leaves:

OP 8: Application for Sabbatical

OP 160: Leave of Absence Without Pay

PD 6 : Leave of Absence for Health Reasons

Form 9902 Page 1 and Form 9902 Page 2

Family Paraprofessional & Hourly Non-Competitive Employee Leave Application

Leave of Absence With Pay Recommendation Form

Educational Paraprofessionals - Leave Application

UFT Educational Paraprofessionals - Borrowing Sick Days Application

Administrative and Pedagogical Staff - Request for leave under the family and medical leave act (FMLA)

OP 198 (Application for Absence due to Personal Illness-Sick Leave) and OP 198-Part 2

PD 19 (Application for Excuse of Absence with Pay for Administrative Employees)

OP 201 (Application for Excuse of Absence without Pay and/or as Non-Attendance for Teachers)

OP 200 Assignment Form

OP 40 Application for Retirement Leave of Absence

Medical:

Mantoux Test Form (TB Test)

Free TB Test Centers

OP 407 Page 1 (Medical Report and Evaluation) and OP 407 Page 2 and OP 407 Instructions

Claim for Loss or Damage of Personal Property Form and Instructions

OP 505 Accident Medical Expense Reimbursement Form and Instructions

OP 505A Assault Medical Expense Reimbursement Form and Instructions

Hardship Transfer Application

Excessing, Transfers, Job Changes:

Application for Reduction of Probationary Service

Application for Layoff Seniority Credit for Paraprofessional
Service

Teaching Service Verification Form (Rule 3)

Veterans' Seniority Credit Verification Request Form for all UFT-covered, school-based staff except educational paraprofessionals

Veterans' Seniority Credit Verification Request Form for educational paraprofessionals

Professional Development:

Summer Stipend Application

Bilingual Pupil Services Application

Recruitment and Selection:

Substitute Teacher Application Packet: 
The New York City Department of Education is currently updating its substitute teaching application process. At this time, no new applications will be accepted without a signed nomination form from the hiring school principal or designee. Please check back in Spring 2010 for the revised application process.

Pedagogical Lic. / Secretary and Lab Specialist

Assignment to Evening High Schools 2005-2006

Application for Parent Coordinator

Applications to become a teacher are submitted electronically at http://www.teachnyc.net.

Certification and Credentialing:

Pedagogical Lic. / Secretary and Lab Specialist

Lab Specialist Exam Announcement (Fall 2007)

DOE Road to Certification Workshop Application
Various school, district and regional based positions require New York State certification. New York State certification is obtained through the New York State Education Department (NYSED).

Visit the NYSED Web site for additional information regarding certification.

Scholarships and Special Programs:

School-Based Option Submission Form

Incentives and Discounts:

Verizon Employee Enrollment Form

Transit Benefits and forms

Separation of Service:

Application for Withdrawal of Resignation/Retirement

Commencement of Service

Authorization for Release of Information