Blank Dhrm L 1 Template

The DHRM Form L-1 is a document issued by the Commonwealth of Virginia that provides a formal notification of layoff or placement for state employees. It outlines the options available to employees facing layoffs, including potential placements in different roles, leave without pay, and the implications of declining positions. Understanding the information and procedures on this form is crucial for employees navigating these challenging circumstances.

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Article Guide

The DHRM L-1 form is an important document for employees being laid off or reassigned within the Commonwealth of Virginia's state agencies. This form serves as a formal notice regarding the status of an employee, outlining their current situation and available options. It includes critical information such as the employee's name, identification number, position, and salary details, which are essential for accurate processing. The form may indicate whether the employee is being laid off, given a new placement, or placed on leave without pay for a specified period. Employees are guided on how to respond to their placement status, including whether they accept the offer, decline in cases of salary reductions or necessary relocations, or choose to explore other opportunities. This notification also highlights the significance of deadlines, as timely completion and submission of the form are crucial to ensuring that management can effectively address the employee's circumstances. Furthermore, the DHRM L-1 form details important rights and benefits, such as recall options, preferential employment opportunities, and severance benefits, providing a comprehensive overview of the employee's entitlements during this transition period.

Form Sample

Attachment B

DHRM Form L-1 Rev. 10/07

Commonwealth of Virginia Notice of Layoff or Placement

First Notice Final Notice

This section is to be completed by the agency human resource officer

Agency

Name

Date

Employee

Employee ID

Name

Number

Position

Role

SOC Code

Number

Pay

Current Semi-Monthly

Band

Salary

Effective

, you

are being placed in the following position:

Role

SOC Code

Position Number

Location

Semi-Monthly Salary

are being placed on leave without pay-layoff for up to 12 months because there is no placement opportunity available to you under the State Layoff Policy.

If you are being placed, options available to you are marked with an X below.

You may decline the placement if it requires relocating your residence, and proceed to the next placement opportunity available to you under the Layoff Policy, if any other options are available. If none are available, I will be placed on leave without pay-layoff for up to 12 months.

You may decline the placement since it is to a position that will result in a salary decrease, and request that you be placed on leave without pay-layoff for up to 12 months.

If you do not accept the placement, your only option is to be separated-layoff because it will not result in salary decrease or need to relocate. You will not be entitled to severance benefits.

Signed	Title


This section is to be filled in by the employee and returned to the human resource officer no later than		.
If you do not return the form by this date, agency management will determine your placement.

I accept the placement described above.

I decline the placement described above because it necessitates relocating my residence. I wish to proceed to the next placement opportunity for which I am eligible, if any are available.

I decline the placement described above because it will result in a salary decrease. I wish to be placed on leave-without pay-layoff for up to 12 months.

I decline the placement described above and understand that I will be separated-layoff with no recall, or preferential employment rights, reemployment opportunity, or severance benefits.

Signed		Date
	The signature above acknowledges receipt of the Notice of Layoff or Placement and a copy of the Layoff Policy.

Notice to employee:

Information on benefits while on leave without pay-layoff is included on the reverse side of this form. If you do not understand it, see your human resource officer.

Side 1 of 2

Recall, Preferential Employment, and Re-employment Opportunity Rights

Recall is the placement of an employee who is on leave without pay-layoff status, demoted in lieu of layoff, or who accepted a position that resulted in a reduction in salary, into a position that is in the employee's pre-layoff Role, salary and agency.

•If you have been placed in a position in your same Role or Pay Band that does not require a salary reduction or relocation, you will have no recall or preferential employment rights. You may apply for openings as otherwise provided by agency policy and the State Hiring Policy.

•If you have been demoted in lieu of layoff, accepted a position that resulted in a reduction in salary, or have been placed on leave without pay-layoff, you will be eligible for recall for up to 12 consecutive months from the effective date of the transaction.

•If you decline recall to your former Role and salary in your former agency, your name will be removed from the recall list, unless the recall was declined because acceptance of the position offered would require residence relocation or reduction in salary.

Preferential Employment is the right of an employee on leave without pay-layoff to obtain a vacant position in other Executive Branch agencies in his/her formerly held Role without competing with candidates outside the hiring agency.

If you are being placed on leave without pay-layoff, you will be eligible for preferential employment and be selected for the position if the following criteria are met:

1.the advertised position is the same Role and Role code as your formerly held position (Role and Role codes are indicated on your preferential hiring card);

2.the agency does not select an applicant who is currently employed within that agency;

3.the agency determines that you are at least minimally qualified for the advertised position;

4.you apply for the position on or before the closing date for receipt of applications;

5.you present an application and your preferential hiring card (DHRM Form L-2) that was issued to you upon layoff; and

6.twelve consecutive months have not passed since the effective date of your leave without pay-layoff.

If you accept a position in another agency in the same Role or in a higher pay band your recall rights will cease, and you must notify the human resource officer of your former agency. Preferential employment does not prohibit you from applying for any externally advertised vacancy and being considered for the position in accordance with the State Hiring Policy.

Re-employment Opportunity is the voluntary program in which employees who choose to participate have their work credentials entered into a computerized database (re-employment opportunity pool) that can be used by Executive Branch agencies in recruiting applicants for vacancies. Employees interested in participating in the pool should complete a Re-employment Opportunity Application form immediately prior to their placement on leave without pay-layoff status.

Severance Benefits

When you are placed on leave without pay-layoff and eligible to receive severance benefits, you may maintain the State's benefits for up to 12 months. However, if you resign, or decline a recall to your former Role that does not involve relocation or salary reduction, your benefits will cease.

Medical Insurance

The State’s contribution toward employee and family medical insurance will continue for the period of leave without pay-layoff (LWOP-layoff) unless you decline recall to your former Role or voluntarily resign before the end of leave without pay-layoff. You will be responsible for the employee’s portion of the health insurance premium. If you wish to change your insurance coverage, you should contact your agency's Benefits Administrator.

Group Life Insurance

The State's contribution toward your group life insurance will continue for the period of LWOP-layoff.

Other Payroll-Deducted Programs

If you participate in other programs (cancer, Deferred Compensation Plan, etc.) through payroll deductions, contact your payroll office to find out how to continue membership in such programs during the time you are on LWOP-layoff.

Retirement

No refund of contributions can be made to you while you are on LWOP-layoff. If you wish to withdraw your VRS contributions, you can do so only by resigning from state service and forfeiting your right of recall and preferential employment.

Severance Pay-out

Eligible full-time employees are entitled to transitional severance benefits when placed on LWOP-layoff based on their number of years of continuous service. Payments cease if reemployed by the State.

Leave Balances

You will be paid at the beginning of your LWOP-layoff for any overtime and compensatory leave balances which you were eligible to accumulate. You may elect to be paid for your annual leave and sick leave (as eligible) at the beginning of your LWOP-layoff or you may leave such balances to your credit for the period of such leave. If you are not paid for these balances, they will be paid upon your separation, per policy. Disability credits are paid only at separation.

Service Credit

You will not be eligible to accrue leave while you are on LWOP-layoff. Time spent on LWOP, up to a maximum of 12 months, will count as active service in determining your annual leave accrual rate, months of service for VSDP, and whether you qualify for payment of 25% of your “traditional” sick leave or disability credit balance on termination. Time spent on LWOP-layoff does not count toward the 12 months probationary period.

The effective date of your eligibility for performance increases upon recall, or upon placement in another agency, will be established by the Performance Planning and Evaluation Policy.

Unemployment Compensation

If you are placed on LWOP-layoff, you should visit the local office of the Virginia Employment Commission to determine your eligibility for unemployment compensation benefits.

Side 2 of 2

⇩ PDF

Document Specifications

Fact Name	Fact Description
Document Title	The form is officially titled "DHRM Form L-1" and is used for layoff notices in Virginia.
Governing Law	This form is governed by Virginia's State Layoff Policy and related employment laws.
Placement Notification	It is used to notify employees of layoff or placement in a different position.
Response Requirement	Employees must return the completed form by a specified deadline to prevent management from making placement decisions.
Leave Without Pay	Employees can be placed on leave without pay for up to 12 months if no placement opportunity is available.
Declining Placement	Employees can decline a placement that requires relocation or results in a salary decrease.
Recall Rights	If placed on leave without pay, employees may be eligible for recall to their former roles for up to 12 months.
Preferential Employment	Employees on leave may pursue vacancies in other agencies for positions similar to their previous roles without competing externally.
Severance Benefits	Eligible employees may receive severance payments based on continuous service years during the leave period.
Unemployment Compensation	Employees on leave without pay should check eligibility for unemployment benefits through the Virginia Employment Commission.

Steps to Filling Out Dhrm L 1

Filling out the DHRM L-1 form is an important step in the layoff process. It ensures that both the employee and the agency are aware of the placement options available. Follow these steps carefully to complete the form correctly.

Gather necessary information: Have the following details ready: agency name, date, employee ID, employee name, role, SOC code, position number, current salary, and other relevant information.
Enter the agency name and date in the designated fields at the top of the form.
Fill in the employee’s name and ID number in the appropriate sections.
Complete the position role, SOC code, and position number.
Input the current semi-monthly salary in the specified field.
Review the notice regarding placement. Indicate your position or leave status by marking the correct options with an “X.”
Sign the form to accept or decline the placement according to your situation (accept or decline based on relocation or salary decrease opportunities).
Date the signature to confirm your acknowledgment of the notice.
Return the completed form to the human resource officer by the specified deadline.

Make sure to keep a copy of the completed form for your records. If you have questions about any section, reach out to your HR department for clarification before submitting the form.

More About Dhrm L 1

What is the DHRM L-1 form?

The DHRM L-1 form is a formal document used by the Commonwealth of Virginia to notify employees about layoff or placement due to job elimination or restructuring. It serves as a notice that outlines the employee's options during this process, including the possibility of being placed on leave without pay for up to 12 months. The HR officer must complete the relevant sections to ensure all necessary information is provided regarding the employee's position and salary.

What are the options available to me when receiving a DHRM L-1 notice?

Upon receiving a DHRM L-1 notice, you have several options. You may accept the new position offered, decline it if it requires relocating or results in a salary decrease, and then choose to proceed to the next available placement opportunity. Alternatively, if no suitable positions exist, you may opt for leave without pay for up to 12 months. Declining the position might lead to separation with no recall or severance benefits, so careful consideration is essential.

What happens if I decide to decline the placement offered?

If you decline the placement, you need to understand the consequences. Accepting a placement that necessitates relocating or that results in a salary reduction can impact your recall and preferential employment rights. Declining without an acceptable reason will lead to your separation from the agency with no rights to recall or severance benefits. It is crucial to respond to the notice within the specified timeframe to avoid agency management making the decision for you.

How do my benefits change if I am placed on leave without pay-layoff?

While on leave without pay-layoff, your medical insurance coverage can continue as long as you meet certain conditions. The state's contribution will remain in place unless you decline recall or resign. However, you will be responsible for paying the employee portion of health premiums. Other benefits like group life insurance will also continue during this period. Be aware that severance benefits may apply to eligible employees, contributing to your financial stability during this transitional phase.

Common mistakes

Incomplete Information: Failing to fill out all required sections of the form can lead to complications. Ensure that the agency name, employee details, and other essential fields are fully completed.
Missing Deadlines: Not returning the form by the specified date can result in the agency making placement decisions without your input. Timing is crucial—adhere to deadlines.
Incorrect Signatures: Skipping the signature line or signing without the correct date may invalidate your submission. Be sure to sign and date the form properly.
Ignoring Placement Options: Overlooking the options regarding placement can be detrimental. Carefully read through the available choices and indicate your preferences clearly.
Not Consulting HR: Failing to seek clarification on the form can lead to misunderstandings. If you're unsure about any section, reach out to your human resource officer.

Documents used along the form

The DHRM Form L-1 is a critical document in the layoff and placement process for employees. Alongside this form, several other documents may be required to effectively manage the situation. Below is a list of forms typically used in conjunction with the DHRM Form L-1 to facilitate the layoff and reemployment processes.

DHRM Form L-2: This is the Preferential Hiring Card issued upon layoff. It grants employees priority consideration for positions in their former role within other Executive Branch agencies, given they meet specific criteria.
Re-employment Opportunity Application: Employees must complete this form prior to being placed on leave without pay. It allows them to enter a database, making their credentials accessible to agencies searching for candidates for vacancies.
Severance Benefits Summary: This document outlines the severance benefits an employee may receive while on leave without pay. It details medical and insurance coverage and conditions affecting these benefits.
Unemployment Compensation Application: Individuals laid off are encouraged to file this application with the Virginia Employment Commission. It assesses their eligibility for unemployment benefits during their period of transition.
Medical Insurance Continuation Notice: This document informs employees about their health insurance while on leave without pay. It highlights any responsibilities regarding premium payments to maintain coverage.
Group Life Insurance Continuation Notice: This outlines how group life insurance coverage is maintained during leave without pay. It clarifies the state's contributions and any actions the employee might need to take.

Each of these documents plays a significant role in ensuring that employees understand their rights and options during layoffs. Familiarity with these forms can help individuals navigate this complex situation more effectively.

Similar forms

The DHRM Form L-1 serves a particular purpose in the context of employee layoffs and placement. Another document that serves a similar function is the Employee Layoff Notification. Like the DHRM Form L-1, this notification informs employees about their layoff status, outlining their rights and options in a straightforward manner. Both documents aim to provide clear communication from the agency to the employee regarding any changes in their job status, ensuring that employees understand their situation and what steps they can take next.

The Separation Notice is another document often used in similar situations. This form outlines the details of an employee’s separation from their position, including the reasons for the separation and any available options for the employee moving forward. Similar to the DHRM Form L-1, it seeks to maintain transparency with the affected employee, detailing the implications of their separation status while also providing information on possible support services.

Employee Status Change Form is also comparable to the DHRM Form L-1. This document records any changes to an employee's work status, such as promotions, demotions, or layoffs. Just as the DHRM Form L-1 details the conditions of layoff and placement options, the Employee Status Change Form must ensure all parties are informed of adjustments to employment status and what that may entail for benefits and responsibilities.

The Record of Employment (ROE) serves a function that is similar as well. An ROE provides an official accounting of an employee's work history and is often used in cases of unemployment claims. It aligns closely with the DHRM Form L-1 in that it offers crucial information regarding an employee's work performance and status at the time of separation or layoff, which can be vital for receiving benefits or finding new employment.

Lastly, the Re-employment Eligibility List is another document tied closely to the themes of the DHRM Form L-1. This list outlines which employees are eligible for re-employment after a layoff. Like the DHRM Form L-1, this document emphasizes the possibility of future employment and the process by which those former employees can be recalled, ensuring that individuals understand their options and are aware of their standing regarding possible future job opportunities within the organization or agency.

Dos and Don'ts

When filling out the DHRM L-1 form, there are several important dos and don’ts to keep in mind.

Do fill out the form completely and accurately to avoid delays.
Do submit the form to your human resource officer by the specified deadline.
Do read the instructions carefully to understand your options and rights.
Do sign and date the form to confirm your acknowledgment of the placement notice.

Don’t leave any required fields blank; unfinished forms may lead to complications.
Don’t wait until the last minute to fill out the form to avoid errors.
Don’t ignore the options provided; make sure you select the choice that best suits your situation.
Don’t forget to keep a copy of the completed form for your records.

Misconceptions

Misconception 1: The DHRM Form L-1 is only for those who are permanently laid off.

This form is used not just for permanent layoffs, but also for temporary layoffs or placements that last up to 12 months. Employees may be re-assigned during this time.

Misconception 2: Employees must accept any position offered to them.

Employees have the option to decline an offered position if it requires relocation or results in a salary decrease. They can opt for leave without pay-layoff instead.

Misconception 3: Acceptance of a new position means loss of all recall rights.

If an employee accepts a position that is in the same role or pay band without a salary reduction, recall rights are not lost. Recall rights only cease if the employee takes a different role or higher pay band.

Misconception 4: Benefits are automatically maintained while on leave without pay-layoff.

Misconception 5: Employees on leave without pay-layoff do not have any job placement options.

Employees on leave have preferential employment rights, allowing them to apply for positions in other agencies similar to their previously held roles without competition from outside candidates.

Misconception 6: All leave balances must be paid out upon layoff.

Employees can choose to be paid for their annual and sick leave balances at the start of their leave without pay-layoff, or they may retain these balances for future accrual.

Misconception 7: Employees cannot seek unemployment compensation if placed on leave without pay-layoff.

Employees placed on leave without pay-layoff can still visit the Virginia Employment Commission to determine their eligibility for unemployment compensation benefits.

Key takeaways

The DHRM L-1 form serves as a critical document for employees facing layoffs or placement options within the Commonwealth of Virginia.
It is essential to provide accurate information, including your employee ID, name, position, and current salary.
Employees have the option to accept or decline a placement that necessitates relocating or results in a salary decrease.
If no suitable positions are available, employees may be placed on leave without pay for up to 12 months.
To ensure all options are considered, timely submission of the completed form to human resources is crucial.
Employees are reminded that declining a placement may lead to separation without severance benefits.
Individuals placed on leave without pay have recall rights for 12 consecutive months if they meet certain criteria.
There is a provision for preferential employment, allowing employees on leave to apply for vacant positions in other agencies without facing external competition.
Coverage for medical and group life insurance typically continues during the leave period unless certain conditions lead to termination of benefits.
Finally, employees should consult with the Virginia Employment Commission to evaluate eligibility for unemployment compensation benefits if placed on leave without pay.