Teacher Request Form For Transfer And/or Intra-School Reassignment

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DOE OHR 200-010
Last Revised: 02/03/2015
TEACHER REQUEST FOR TRANSFER
TEACHER REQUEST FOR TRANSFER
Former DOE Form(s): 101b
AND/OR INTRA-SCHOOL
AND/OR INTRA-SCHOOL
DEPARTMENT OF EDUCATION
Office of Human Resources
REASSIGNMENT
REASSIGNMENT
Reclassification Unit
P.O. Box 2360 Honolulu, HI 96804
Transfer Request to
Intra-School Reassignment Request:
School: _____________________________________________
I would like to be considered for a vacancy at this
school in another subject or grade level for which I am
Position: _____________________________________________
qualified.
Position Number: ______________________________________
Posting Announcement No.: ______________________________
I. EMPLOYEE INFORMATION
Name: _____________________________________________________________
Employee ID: __________________________
Last
First
M.I.
Address: _________________________________________
City: _____________________ State: _______ Zip: ______________
Current School/Office: _____________________________ School/Office Tel#: _________________ Home Tel#: _________________
This
Tenured or
Satisfactory Probationary (serving in last semester of probation)
Principal/Administrator Signature (optional): _________________________________________ Date: __________________________
MM/DD/YYYY
II. AREA(S) OF PREPARATION AND SENIORITY IN THE DEPARTMENT OF EDUCATION
Check Area(s) of preparation for which you are licensed by Hawaii:
Elementary
Early Childhood
Middle School (List Highly Qualified Subjects): ______________________________________________________________
Secondary (List Highly Qualified Subjects): ___________________________________________________________________
K-12 (List Highly Qualified Subjects): ________________________________________________________________________
School Counselor
School Librarian
Special Education:
Mild/Moderate
Severe/Profound
Other: ______________________
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.)
School
Subject
Year(s)
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. _____________________________________________________________________________________________________
(Page 1 of 2)
Distribution: Refer to distribution instructions in Section V. of the form.

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