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New Jersey Civil Service Commission

Division of Classification and Personnel Management - Intergovernmental Services Unit

P.O. Box 313, Trenton, New Jersey 08625-0313

INTERGOVERNMENTAL TRANSFER WAIVER OF RIGHTS

Law Enforcement Waiver Requests

(Request to Waive All Accumulated Seniority and/or Sick Leave)

I ____________________________________________________________ hereby request to waive the following rights:

Transferee Name

SENIORITY WAIVER

Employees seeking intergovernmental transfers in Law Enforcement titles shall be granted the option to waive retention

of rights to all accumulated seniority. By authorized signature of transferee below, a waiver has been requested:

I request to waive my rights to all accumulated seniority and authorize the Civil Service Commission to

facilitate an intergovernmental transfer as specified in the attached Intergovernmental Transfer

Agreement (DPF-721).

Transferee’s Signature: _________________________________________________________________ Date: ____________________

SICK LEAVE WAIVER

Employees seeking intergovernmental transfers in Law Enforcement titles shall be granted the option to waive

retention of rights to all accrued sick leave. By authorized signature of transferee below, a waiver has been

requested:

I request to waive my rights to all accrued sick leave and authorize the Civil Service Commission to facilitate

an intergovernmental transfer as specified in the attached Intergovernmental Transfer Agreement (DPF-721).

By signing this waiver, I further acknowledge that no supplemental compensation for accrued sick leave has

or will be paid to me.

Transferee’s Signature: _________________________________________________________________ Date: ____________________

RECEIVING AGENCY ACKNOWLEDGEMENT OF WAVIER

________________________________________

As the Receiving Agency’s authorized signing authority, I

signing below, acknowledge such waiver signed by the above named transferee and certify that accumulated seniority

and/or sick leave will not be retained after effectuation of the intergovernmental transfer.

: _______________

Appointing Authority Signature: __________________________________________________________ Date

NEW JERSEY CIVIL SERVICE COMMISSION

AUTHORIZATION OF SENIORITY AND/OR SICK LEAVE WAIVER

A Seniority and/or Sick Leave Waiver have been signed by the transferee. The Receiving Agency’s authorized

signing authority has acknowledged such waiver and certified the employee’s accumulated seniority and sick

leave will not be retained after effectuation of the intergovernmental transfer. The Sending Agency’s authorized

signing authority has certified that no supplemental compensation has or will be paid to the employee.

_____________________________________________________________

____________________________

______________

CSC Authorized Signature

Title

Date

DPF-721 Supplemental Law Enforcement Waiver Revised 5/30/12

Form Dpf-721 - Intergovernmental Transfer Agreement - New Jersey State Civil Service Commission Page 3