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Request Prior Service/Sick Time Balance to be Transferred from MetroHealth to my New Employer

Please submit this form if you are requesting that your prior service and/or sick time balance be transferred from MetroHealth to your new employer. Please allow 5 business days for processing.

First name
Please enter your first name.
Last name
Please enter your last name.
E-mail address
Please enter your email address.
Preferred Phone number
Please enter your phone number.
(10-Digit Phone number, like: 2167778888)
Employee ID#
Please enter your Employee ID#.
New OPERS Employer
Please enter your new OPERS employer.
Employer Address
Please enter the new employer address.
City
Please enter the city of your new employer.
State
Please enter the state of your new employer.
Zip Code
Please enter the zip code of your new employer.
Employee Name While Employed at MetroHealth
Please enter your name while employed at MetroHealth.
Please select which option you are requesting:
Please select which option you are requesting.
Please attach the prior service form you wish to have completed. If you do not attach a specific form to be completed from your new employer, we will return an employment verification letter to you including your sick time balance.
Please attach the prior service form you wish to have completed.