Employee/Employer Forms
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DMA 5.3-1-R & 5.3-2-R — Authorization for Release of Health Care Information *
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DMA 5.3-R — Occupational Health Medical History Form *
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DMA 5.3-4-R — MASO Physical Readiness Test Pre-Hire, Annual and Return-to-Work
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DMA 8 — Authorization For Disclosure or Exchange of Confidential Medical Records
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DMA 12-E-R — Position Action Request *
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DMA 23-E — Request for Approval of Outside Employment
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DMA 35 — DMA State Employee Performance Evaluation
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DMA 38-E — DMA State Training Traveling Request/Authorization
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DMA 39 — Request for FLSA Exempt OverTime
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DMA 171 — DMA SSID and Facility Access Request
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DMA 172 — JFHQ-WI Facility Access Request EAL (xlsx download)
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DMA 217 — Disability Self-Identification
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DOA 6125 – Physicians Certification
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DOA 15100 – Veterans New Hire Information
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DOA 15302 – Position Description
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DOA 15104 – Reasonable Accommodation Request Form
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DOA 15308 – Leave Without Pay (LWOP) Request/Authorization
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DOA 15322 – Family & Medical Leave (FMLA) Request Form
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DOA 15330 – Justification for Discretionary Merit, Equity or Retention Award (DMC/DERA)
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DOA 15336 – Fitness For Duty Certification – Return To Work Release
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DOA-15519 – Limited Term Employment Acknowledgment
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DOA 15802 – Adverse Employment Action Employee Grievance
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DOA 15805 – Condition of Employment – Employee Grievance Report
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USCIS I-9 Form Employment Eligibility Verification
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DMA – Hiring Justification
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DMA – Retirement/Resignation Notice
Workers Compensation Forms
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DOA 6058 — Employee Workplace Injury or Illness Report
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DOA 6437 — Supv & Safety Coord Investigation Report for Injury or Illness
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DOA 15336 — Fitness For Duty Certification – Return To Work Release
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Employee Workplace Injury or Illness Report Guidelines
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WKC 12 E — Employer’s First Report of Injury or Disease
Family Medical Leave Act (FMLA) Forms
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Family Medical Leave Act (FMLA) Forms
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DOA 15336 Fitness For Duty Certification – Return To Work Release
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DOL WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition
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DOL WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition
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DOA 15322 — FAMILY AND MEDICAL LEAVE (FMLA) REQUEST
DMA Employee
**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**