DHMH WORK STUDY/RELEASE OBLIGATED SERVICE AGREEMENT

Training Services Division, Office of Human Resources, dhmh

This Obligated Service Agreement, hereafter referred to as “agreement”, is entered into between the employee named below and the Department of Health and Mental Hygiene (DHMH).

  1. I
/ (Print/Type) / an employee about to participate from to in the MarylandDepartment of Health

and Mental Hygiene’s Work-Study/Release Program, agree to abide by the requirements of this program as defined in the Work-Study/Release Guidelines. If my WorkStudy/Release application is approved, I(a) will participate in and complete the program to the best of my ability and my grades will not fall below a C and (b) will remain an employee of the DHMH following completion of my specified educational program for theobligated service repayment period required. I understand that if I move to another position within the DHMH I am still bound to the Obligated Service agreement and must continue repayment until it has reached a 0 balance.

  1. If I leave the DHMH or withdraw from the program, I am legally obligated and agree that any pre-calculated work study/release time not paid back in service hours would be converted to cash owed to the DHMH. For example, if I still owed the DHMH 12 weeks of obligated service, that time would be converted to 12 weeks of my salary, which would be paid back in full to the DHMH. If I leave DHMH State service and return within three years, the cash repayment will cease and service hour repayment will begin until I have reached a 0 balance. It is my responsibility to contact the Training Services Division upon my return.
  2. All work study/release service hours must be listed on my timesheet using CODE 79. Service hours or cash repayment will be based on time used for work study/release hours.
  3. I agree that the obligated service repayment period shall be computed by the Training Services Division. The repayment of obligated service shall commence on the first work day when I return to full-time dutyfollowing completion of my specified program or by withdrawal under any other circumstance.
  4. I agree that the amount which becomes due the DHMH as a result of my failure to meet the terms of this agreement may be withheld from any money due me from the DHMH,including garnished wages.

TIMEKEEPING CONVERSION CHART AND FORMULA
  • Up to 10 hours per week of work study time per week of work study time = hour per hour payback
  • Any work study time 11 hours through 20 hours per week = 1.5 times per hour payback
  • Any work study time 21 hours through 40 hours per week = 3 times per hour payback
  • NOTE: DO NOT INCLUDE STATE HOLIDAY OR RELEASE DATES IN YOUR CALCULATIONS
HOURS
  1. Work Study/Release hoursper week =
  2. Number of Weeks Covered=
  3. A x B= total number of hours taken
  4. C x Conversion Amount = of Obligated Service Hour repaymentrequired for this Semester/Course
CASH:
Based on the information provided by the Training Services Division, the DHMHAccounting
Department will determine and collect the required cash repayment amount.
Employee Signature: / Date:
Supervisor’s Name/Title (Print): / Phone #:
Supervisor Signature: / Date:
Appointing Authority/Title(Print): / Phone #:
Appointing Authority Signature: / Date:

++++++++++++++++++++++++++++++++++++++FOR DHMH USE ONLY+++++++++++++++++++++++++++++++++++++

Training Services Name/Print: / Phone:410-767-1605
Training Services Signature: / Date: