Fillable Printable Teacher Request for Transfer - Hawaii
Fillable Printable Teacher Request for Transfer - Hawaii
Teacher Request for Transfer - Hawaii
DOE OHR 200-010
Last Revised: 02/03/2015
Former DOE Form(s): 101b
DEPARTMENT OF EDUCATION
Office of Human Resources
Reclassification Unit
P.O. Box 2360 Honolulu, HI 96804
Transfer Request toIntra-School Reassignment Request:
School:_____________________________________________
Position:_____________________________________________
Position Number:
______________________________________
Posting Announcement No.:______________________________
I. EMPLOYEE INFORMATION
Name: _____________________________________________________________Employee ID: __________________________
LastFirstM.I.
Address: _________________________________________City: _____________________State: _______Zip: ______________
Current School/Office: _____________________________
School/Office Tel#: _________________
Home Tel#: _________________
ThisTenured or Satisfactory Probationary (serving in last semester of probation)
Principal/Administrator Signature (optional): _________________________________________
Date: __________________________
II. AREA(S) OF PREPARATION AND SENIORITY IN THE DEPARTMENT OF EDUCATION
Check Area(s) of preparation for which you are licensed by Hawaii:
ElementaryEarly Childhood
Middle School (List Highly Qualified Subjects): ______________________________________________________________
Secondary (List Highly Qualified Subjects): ___________________________________________________________________
K-12 (List Highly Qualified Subjects): ________________________________________________________________________
School CounselorSchool Librarian
Special Education:
Mild/ModerateSevere/ProfoundOther: ______________________
Seniority:
Years: ______________
Months: ______________
III. PROFESSIONAL EXPERIENCE, SPECIAL ABILITIES, AND TEACHING SKILLS
You may attach any additional information to this form to further inform the principal of your full qualifications.
Teaching Experience: (State with your most recent position. Add attachment if more space is needed.)
1. ___________________________________________________________________________________________________
2. ___________________________________________________________________________________________________
3. ___________________________________________________________________________________________________
Special Abilities (Drama, Newswriting, Coaching, Computers, etc.):
Other Experiences Related to the Assignment: (YWCA, Teaching Assignment, UH-English Department, etc.):
1. _____________________________________________________________________________________________________
2. _____________________________________________________________________________________________________
3. _____________________________________________________________________________________________________
TEACHER REQUEST FOR TRANSFER
AND/OR INTRA-SCHOOL
REASSIGNMENT
TEACHER REQUEST FOR TRANSFER
AND/OR INTRA-SCHOOL
REASSIGNMENT
School
MM/DD/YYYY
I would like to be considered for a vacancy at this
school in another subject or grade level for which I am
qualified.
Subject
Year(s)
Distribution: Refer to distribution instructions in Section V. of the form.
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DOE OHR 200-010
Last Revised: 02/03/2015
Former DOE Form(s): 101b
Teaching Skills: List the specific job-related skills you possess that will enable you to perform effectively in this position.
1. _____________________________________________________________________________________________________
2. _____________________________________________________________________________________________________
3. _____________________________________________________________________________________________________
IV. CERTIFICATION
I hereby certify that the above information regarding my qualifications is accurate to the best of my knowledge and belief.
Teacher LegalSignature: ______________________________________
Date: __________________________
General Information
Duplicate the DOE OHR 200-010 as needed.
DOE OHR 200-010 - Teacher Request for Transfer Instructions:
1.
2.
3.
4.
a)the principal/supervisor who listed the vacancy,
b)the appropriate Personnel Officer of the school district to which transfer is requested,
c)your respective Personnel Officer, and
d)employee copy.
VI. DIRECTORY OF PERSONNEL REGIONAL OFFICERS
Honolulu Personnel Regional OfficeLeeward Personnel Regional OfficeMaui Personnel Regional Office
4967 Kilauea Avenue
601 Kamokila Boulevard #58854 High Street, 4th Floor
Honolulu, HI 96816Kapolei, HI 96707Wailuku, HI 96793
Telephone: 733-4870Telephone: 692-8007Telephone: 984-8010
Central Personnel Regional OfficeWindward Personnel Regional Office
Kauai Personnel Regional Office
1122 Mapunapuna Street Suite #20046-169 Kamehameha Highway3060 Eiwa Street
Honolulu, HI 96819Kaneohe, HI 96744Lihue, HI 96766
Telephone 831-6855Telephone: 233-5703Telephone: 274-3506
Hawaii Personnel Regional Office
75 Aupuni Street, Room 203
Hilo, HI 96720
Telephone: 974-6605
V. INSTRUCTIONS FOR COMPLETING DOE OHR 200-010 TEACHER REQUEST FOR TRANSFER/INTRA-SCHOOL
RE-ASSIGNMENT
The DOE OHR 200-010 is the mechanismto indicate a teacher's interest in an advertised vacancy or an intra-school re-assignment.
A completed form must be received by the principal of the school which listed the vacancy within the posting period. Forms
received after the closing date of the posting period may not be considered.
Distribution of DOE OHR 200-010 - The completed DOE OHR 200-010 must be reproduced and distributed to the following:
A completed copy of the DOE OHR 200-010 must be submitted (at the earliest time possible) to the home school principal of the
teacher who is requesting intra-school re-assignment.
Teacher initiates request to transfer and/or for re-assignment by indication on the DOE OHR 200-010, Teacher Request for
Transfer/Intra-School Re-Assignment.
Principal/Supervisor acknowledgement of request to transfer and/or for re-assignment will be verified by dated signature on this
form and distributed accordingly (optional).
If requesting intra-school re-assignment, the completed DOE OHR 200-010 is submitted to only your present principal. Keep
one (1) copy for your record.
MM/DD/YYYY
A teacher requesting a transfer must ensure that the form is fullycompleted and submitted in a timelymanner.
Distribution: Refer to distribution instructions in Section V. of the form.
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