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Wisconsin

Department of Military Affairs

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  • Home
  • About DMA
    • News
    • DMA Leadership
    • Community Relations
    • Legal & Administrative
    • Open Records/FOIA
  • Careers
    • Employment Opportunities
    • Federal Human Resources Office
    • State Employment Opportunities
  • Resources
    • Education
    • Equal Opportunity and Equal Employment Opportunity (EO & EEO)
    • Flag Lowering Orders
    • State Human Resources Office
      • Employee Resources
      • Forms
      • Practice and Procedure Bulletins
      • Risk Management
      • State Equity and Inclusion
      • Travel, Lodging & Vehicle Use
    • TAG Memos
    • Veterans
    • Retiree Activities Office
    • Links
  • Contact
    • Subscriptions
© 2022 Wisconsin Department of Military Affairs.

Forms

Employee/Employer Forms

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

  • 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

Workers Compensation Forms

  • DOA 6058 — Employee Workplace Injury or Illness Report
  • DOA 6437 — Supv & Safety Coord Investigation Report for Injury or Illness
  • DOA 15336 — Fitness For Duty Certification – Return To Work Release
  • Employee Workplace Injury or Illness Report Guidelines
  • WKC 12 E — Employer’s First Report of Injury or Disease

Family Medical Leave Act (FMLA) Forms

  • Family Medical Leave Act (FMLA) Forms
  • DOA 15336 Fitness For Duty Certification – Return To Work Release
  • 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
  • DOA 15322 — FAMILY AND MEDICAL LEAVE (FMLA) REQUEST

DMA Employee

  • DMA Memorandum Employee Work Rules
  • DMA Form Employee Work Rules Receipt

**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

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2400 Wright Street, Madison, WI 53708
608-242-3000
ng.wi.wiarng.mbx.wi-pao@army.mil
Legal & Administrative | Records Requests/FOIA
© 2022 Wisconsin Department of Military Affairs.

Equal Opportunity Employer