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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 23-E  Request for Approval of Outside EmploymentPDF 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 171  DMA SSID and Facility Access Request PDF file
DMA 172  JFHQ-WI Facility Access Request EAL Excl file
DMA 217  Disability Self-Identification  PDF file
DOA 6125  Physicians Certification pdf doc
DOA 15100  Veterans New Hire Information pdf doc
DOA 15104  Reasonable Accommodation Request Form pdf file
DOA 15302  Position Description URL
DOA 15308  Leave Without Pay (LWOP) Request/Authorization internet link
DOA 15330 Justification for Discretionary Merit, Equity or Retention Award (DMC/DERA) doc
DOA 15336  Fitness For Duty Certification – Return To Work Release PDF file
DOA 15802  Adverse Employment Action Employee GrievancePDF file
DOA 15805  Condition of Employment - Employee Grievance ReportPDF file
USCIS I-9 Form  Employment Eligibility Verification pdf file
5.3-4-R Form  Physical Readiness Test Results 5.3-4-R docx file
DMA Form Employee Work Rule Receipt PDF file **Please review the links below for WHRH Chapters 408 and 410 prior to signing the Employee Work Rule Receipt Form DMA Form Self-Reporting Derogatory InformationPDF file
DMA Form Confidentiality Non Disclosure AgreementPDF file

Workers Compensation Forms

DOA-6058 Employee Workplace Injury or Illness Report PDF file
DOA-6437 Supv & Safety Coord Investigation Report for Injury or IllnessPDF file
DOA-15336  Fitness For Duty Certification – Return To Work Release PDF file
Employee Workplace Injury or Illness Report GuidelinesPDF file
WKC-12-E Employer's First Report of Injury or Disease PDF file

Family Medical Leave Forms (FMLA)

DOA 15336  Fitness For Duty Certification – Return To Work Release PDF file
DOL WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition
DOL WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition
DCLR-201 Family and Medical Leave - Employee Request

DMA_Icon  State HR Menu

DMA_Icon  State Human Resources

Email
Phone
(608) 242-3153
Location
2400 Wright Street
Madison, Wisconsin
Mailing Address
Department of Military Affairs
WING-SHR
P.O. Box 14587
Madison, WI 53708-0587
AA Officer
Director, State Human Resources,
Department of Military Affairs
WORK: (608)242-3163
FAX: (608) 242-3168
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