Request for Transfer of Prior State Service Credit and Sick Leave

This form is submitted to an employee’s previous employer to request a transfer of prior state service credit and sick leave hours. Sick leave balance is transferable within 10 years following separation from previous eligible public agency with verification.

To submit your form:

1. Locate the form in the Attachments section.

2. Complete all required fields. Send to previous employer(s) for completion of Section 2.

3. Once finished, click the Upload Form button and attach your completed document.