Governor - Scott K. Walker Adjutant General - Major General Donald P. Dunbar

Employee/Employer Forms

* Fillable PDF - Use IE browser or right click and save to desktop

DMA 002  State Active Duty Pay Authorization  PDF file *
DMA 5.3-1-R & 5.3-2-R  Authorization for Release of Health Care Information  PDF file *
DMA 5.3-R  Occupational Health Medical History Form  PDF file *
DMA 5.3-3-R  Military Affairs Security Officer/Supervisor (MASO) Physical Agility Test PDF file *
DMA 8  Authorization For Disclosure or Exchange of Confidential Medical Records PDF file
DMA 12-E-R  Position Action RequestPDF file *
DMA 35  DMA State Employee Performance Evaluation PDF file
DMA 38-E  DMA State Training Traveling Request/Authorization PDF file
DMA 39  Request for FLSA Exempt OverTime PDF file
DMA 100  Business Card Request PDF file
DMA 120  Request for Electronic Access Key (EAK) & Facility Access PDF file
DMA 217  Disability Self-Identification  PDF file
DOA 6125  Physicians Certification pdf doc
DOA 15802  Adverse Employment Action Employee GrievancePDF file
DOA 15805  Condition of Employment - Employee Grievance ReportPDF file
DOA 15104  Reasonable Accommodation Request Form pdf file
DOA 15308  Leave Without Pay (LWOP) Request/Authorization word doc
DOA 15330  Justification for Discretionary Merit Compensation (DMC) Award  doc
DOA 15332  Justification for Discretionary Equity or Retention Adjustment (DERA)  doc
DOA 15302  Position Description URL

Safety Forms

Supv & Safety Coord Investigation Report for Injury or Illness Guidelines word doc


Employee Workplace Injury or Illness Report - Workers Compensation FormsPDF file

Employee Workplace Injury or Illness Report GuidelinesPDF file


Supv & Safety Coord Investigation Report for Injury or Illness PDF file

WKC-12-E Employer's First Report of Injury or Disease PDF file
DOL WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition - Family Medical Leaveurl
DOL WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Conditionurl
DCLR-201 Family and Medical Leave - Employee Request url
State Human Resources Office
Phone: (608) 242-3153
Fax: (608) 242-3168

2400 Wright Street
Madison, Wisconsin

Mailing Address:
Department of Military Affairs
P.O. Box 14587
Madison, WI 53708-0587

AA Officer
Joni Mathews
Director, State Human Resources
Department of Military Affairs
Work: (608) 242-3163
Fax: (608) 242-3168
Cell: (608) 218-0406