Local 1070 Court, County and Department of Probation Employees

Forms

UNIFIED COURT SYSTEM EMPLOYEES ONLY

To apply for the  sick leave bank, you and your doctor must fill out the attached form completely. You may either fax or mail the completed form to the fax number or to the address on the form, NOT Local 1070 office. The date that the Labor Relations Office receive the form will be considered the date of submission.

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This listing is updated monthly. You must verify that the dentist is still participating in DC 37 Health and Security plan at the time you call to schedule an appointment and when you receive your dental treatment. Please click this link www.dc37.net  then click the Benefits tab; Health & Security tab; Dental tab. Read more >>>

Please read  and follow all the instructions. Your claim may be delayed or returned if this form is  iincomplete. Read more >>>

This completed and notarized Change of Beneficiary Form will designate who will receive your Death Benefit. It is very important to keep this form updated. Read more >>>

In order for the DC 37 Health and Security Plan to provide Welfare Fund Benefits to you and your dependents you must complete the attached Enrollment form. Read more >>>

We like hearing from you. Fill out the comments, questions and/or suggestions form and email, fax or mail to us. Read more >>>

 Find attached the DC37 Health and Security Plan Dental claim form.  Read more >>>

To replace an optical voucher, this form must be completed, notarized and returned to DC 37 Health and Security Department, 125 Barclay Street, 8th Floor, NY NY 10007.  Read more >>>

To replace a lost or stolen drug I.D. card, please print out the form and provide the requested information. Return the form to DC 37 Health and Security, 125 Barclay Street, 8th Floor, New York, NY 10007. Read more >>>

 According to  Rules of the Chief Judge; Part 25: Career Service, Statue 25.5-Classification and Allocation-Section (d) Review of classification and allocation. Any nonjudicial employee, employee organization or court administrator directly concerned in any classification or allocation of a position in the Unified Court System may seek review of that classification or allocation by submitting a request, in writing, to the director of personnel of the Unified Court System setting forth the basis of the change requested, together with any supporting papers. The director of personnel shall conduct such inquiry as is necessary and recommend to the Chief Administrator any required adjustments in the classification or allocation. The Chief Administrator shall determine the request for review and shall notify the employee, employee organization or administrator of that determination. Read more >>>

This form is for both our city and state members.  If you enroll (or change) any dependents, spouse or domestic partner, it is MANDATORY  that you attach all required documents,  for example:  BIRTH CERTIFICATE, MARRIAGE CERTIFICATE, ADOPTION DOCUMENTS, REGISTRATION OF DOMESTIC PARTNERS OR DIVORCE PAPERS before any benefits will be provided to dependents, spouse or domestic partner. Read more >>>

 This form is for our State Members only. Read more >>>

 Attached is a Notice of Exposure Incident Form.  Once completed keep a copy for your records. Read more >>>

Pursuant to Section 23.1(a) of the 2011-2016 Agreement between the State of New York-Unified Court System and DC-37,  Local 1070 competitive class title members may submit a Voluntary Request for Reassignment  (transfer) form to the Office of Court Administration.

The term "reassignment" (transfer) means the change, without further examination, of a permanent employee from his or her present permanent title, position in the same grade and salary under a different administrative authority. 

This form must be filled out completely and mail to Albany, New York.

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As pursuant to Section 23.2(a) of the 2011-2016 Agreement between the State of New York - Unified Court System and DC 37, Local 1070 the VOLUNTARY CHANGE IN ASSIGNMENT FORM is now available.  PLEASE CLICK THE LINK ABOVE FOR MORE INFORMATION AND THE FORM. Read more >>>

Please read  the attached form carefully. Claims filed later than 30 days from the date of service will be declared ineligible. Read more >>>

The new optical reimbursment claim form for the State Employees only is now available. PLEASE CLICK THE LINK ABOVE FOR THE FORM. Read more >>>

See pages 4 and 5 for instructions on completing this form. Albany will not accept fax applications. You must answer all questions in ink and the application must be signed and notarized, if not, it will be rejected.

To apply for reimbursement, a member must submit an original application form for the term. At the end of the term, the member must submit a completed application form along with a grade report or completion of course documentation. This information must be received no later than 120 days after the last day of class.

If you have taken a prep course, i.e. for an  upcoming exams, you must pay up front and submit a completed application form, a letter of completion and a copy of your receipt to get the reimbursement. 

Please read the instructions carefully.

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