State Human Resources Office

Employee/Employer Forms

* Fillable PDF - Use IE browser or right click and save to desktop
DMA 002  State Active Duty Pay Authorization  *
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  
DMA 217  Disability Self-Identification
DOA 6125  Physicians Certification
DOA 15100  Veterans New Hire Information
DOA 15104  Reasonable Accommodation Request Form
DOA 15302  Position Description
DOA 15308  Leave Without Pay (LWOP) Request/Authorization 
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  

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** DMA Form Self-Reporting Derogatory Information
DMA Form Confidentiality Non Disclosure Agreement
DMA Employee Information Form

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 Forms (FMLA)

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
DCLR-201 Family and Medical Leave - Employee Request


DMA_Icon  State HR Menu

DMA_Icon  State Human Resources

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