Forms

Employee/Employer Forms

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DMA — Retirement/Resignation Notice
DMA 5.3-1-R & 5.3-2-R — Authorization for Release of Health Care Information *
DMA 5.3-R — Occupational Health Medical History Form *
DMA 5.3-4-R — MASO Physical Readiness Test Pre-Hire, Annual and Return-to-Work
DMA 8 — Authorization For Disclosure or Exchange of Confidential Medical Records
DMA 12-E-R — Position Action Request *
DMA 23-E — Request for Approval of Outside Employment
DMA 35 — DMA State Employee Performance Evaluation
DMA 38-E — DMA State Training Traveling Request/Authorization
DMA 39 — Request for FLSA Exempt OverTime
DMA 171 — DMA SSID and Facility Access Request
DMA 172 — JFHQ-WI Facility Access Request EAL (xlsx download)
DMA 217 — Disability Self-Identification
DOA 6125 – Physicians Certification
DOA 15100 – Veterans New Hire Information
DOA 15302 – Position Description
DOA 15104 – Reasonable Accommodation Request Form
DOA 15308 – Leave Without Pay (LWOP) Request/Authorization
DOA 15322 – Family & Medical Leave (FMLA) Request Form
DOA 15330 – Justification for Discretionary Merit, Equity or Retention Award (DMC/DERA)
DOA 15336 – Fitness For Duty Certification – Return To Work Release
DOA-15519 – Limited Term Employment Acknowledgment
DOA 15802 – Adverse Employment Action Employee Grievance
DOA 15805 – Condition of Employment – Employee Grievance Report
USCIS I-9 Form Employment Eligibility Verification

**Please review the Memorandum and the WHRH Chapters 408 and 410 linked in the memorandum and below prior to signing the Employee Work Rules Receipt Form**

WI Human Resources Handbook Chapter 408
WI Human Resources Handbook Chapter 410
DMA Form – Self-Reporting Derogatory Information
DMA Form – Confidentiality Non Disclosure Agreement
DMA Employee Information Form
DMA Form 217 Self-ID Disability
DOA-15100 Veterans New Hire Information

Employee/Employer Forms

Workers Compensation Forms

Family Medical Leave Act (FMLA) Forms

DMA Employee