Form Ct-Hr-28 - Request To Hold Classified Position
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2State of Connecticut Human Resources
Request to Hold Classified Position in Accordance with C.G.S. Section 5-248(f)
Form #: CT-HR-28
Revision Date: 06/07/2016
Background: CGS Section 5-248(f) as amended by Public Act 13-247 states: “A classified employee with at
least five years of state service appointed to an unclassified position may be granted a leave of absence without
pay from the classified service by the Commissioner of Administrative Services for such length of time as he or
she shall hold such appointive position, except that no such leave of absence shall exceed two consecutive
years unless such classified employee requests and is granted a renewal of such leave of absence by the
commissioner.
Section 1: To be completed by the employee
Check One:
Original Request: _____
Request for Extension: _____
Employee Name: ____________________________________ Employee ID: _________
Current Classified Official Job Title: ________________________________________
Agency: _____________________________________________________________
Unclassified Official Job Title: ____________________________________________
Agency: _____________________________________________________________
Date of appointment to the unclassified service: ______________________________
In accordance with CGS Section 5-248(f), I am requesting an unpaid leave of absence from my current classified
position to serve in a position in the unclassified service.
I understand:
•
I must have at least 5 years of state service to make this request.
•
The approval of this request is at the discretion of my agency head and the Commissioner of
Administrative Services.
•
If approved, the leave of absence will be for a maximum of two years, unless I request and am granted
an extension.
•
If my unclassified position or agency changes, a new request must be made.
•
If the agency where my position is held merged into another agency, a new request must be made.
•
Any extension must be requested in writing and approved by my agency head and the Commissioner of
Administrative Services.
Signature: ____________________________________________ Date: _______________
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