Forms

Human Resources

TopicFormEntity
Reporting Child Abuse and Neglect

State of Maryland-Child Protective Services Report of Suspected Child Abuse/Neglect

Important Information:
DCPS Reporting Procedures
DCPS Child Abuse and Neglect FAQ
DCPS Reporting Child Abuse and Neglect Handbook

MD DHS
 Change of Address Name Address Change Form or Employee Access Center  DCPS

Benefits

TopicFormEntity
Healthcare Application BCBS Application BlueCross BlueShield
FSA Application 2014 FSA Enrollment Form HFS Benefits
FSA Medical Reimbursement FSA Medical Reimbursement Form HFS Benefits
FSA Dependent Care Reimbursement Form FSA Dependent Care Reimbursement Form HFS Benefits
Life Insurance Beneficiary Designation

Prudential Benefits

In the Control Number field, please enter 51586

Prudential
Tuition Reimbursement DCPS Course Approval and Reimbursement DCPS

Workers' Compensation

TopicFormEntity
Decision tree Employee Injury Decision Tree  DCPS
Employee Injury Report Employee Injury Report MABE  DCPS
Supervisor Report Supervisor Injury Report MABE  DCPS

Family Medical Leave

TopicFormEntity
 FMLA Poster (2/2013) FMLA Poster  DOL
 FMLA Request form DCPS FMLA Request Form  DCPS
 FMLA Supervisor form DCPS FMLA Supervisor Form  DCPS
 Employee Serious Health WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition (PDF)  DOL
 Family Member Health WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition (PDF)  DOL
 Eligibility Notice WH-381 Notice of Eligibility and Rights & Responsibilities (PDF)  DOL
 Designation Notice WH-382 Designation Notice (PDF)  DOL
 Exigency for Military WH-384 Certification of Qualifying Exigency For Military Family Leave (PDF)  DOL
 Current Servicemember WH-385 Certification for Serious Injury or Illness of Current Servicemember -- for Military Family Leave (PDF)  DOL
 Veteran Caregiver WH-385-V Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (PDF)  DOL
 Return to work form DCPS Return to Work Medical Certification Form  DCPS

Payroll

TopicFormEntity
Federal Tax Withholding Form W-4 (2016)  Federal
Employee’s Maryland Withholding Exemption Certificate MARYLAND FORM MW507  State
Direct Deposit Authorization Direct Deposit Authorization Agreement Form  DCPS
Summer Savings DCPS Summer Savings Form  DCPS
20/24 Pays (10 month/12 month) DCPS 24 Pay Plan Form  DCPS
Support Employee Salary Change Support Employee Salary Change Form  DCPS
DCPS Calendar DCPS Calendar  DCPS
Duty Days DCPS Duty Days 2016 - 2017  DCPS
Ten-Month Employee Work Calendar Ten-Month Employee Work Calendar  DCPS
Eleven- and Twelve-Month Employee Work Calendar Eleven- and Twelve-Month Employee Work Calendar  DCPS
Pay Dates Pay Dates 2016 - 2017  DCPS
Payroll Schedule with Due Dates 2016 - 2017 Payroll Schedule with Due Dates  DCPS

New Hire

TopicFormEntity
New Hire Handbook DCPS New Hire Forms Handbook DCPS
I-9, Employment Eligibility Verification I-9 Form Federal
Consent for release of information / background clearance request MD Release / Background Clearance Request State
Maryland New Hire Registry Reporting Form MD New Hire Form State
Pamphlet Welcome to the Employees’ and Teachers’ Pension System Welcome to Reformed ETPS State
Application for membership (Form 001) Form 001 State
Designation of beneficiary (Form 004) Form 004 State
Application for criminal history record check Criminal History Record Check Form DCPS
DCPS background supplemental form Application for Supplemental Background Check DCPS
Teacher Employment Verification Form DCPS Employment Verification Form DCPS
New Hire Form DCPS New Hire Form DCPS
A&S / Support Unit I / Support Unit II / Teachers Negotiated Agreements DCPS
Initial Application for Certification Maryland State Department of Education's educator certification portal MSDE
Verification of satisfactory educational experience Verification of Experience MSDE