Employee/Employer Forms

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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 5.3-3-R  Military Affairs Security Officer/Supervisor (MASO) Physical Agility Test  *
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 100  Business Card Request
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 15802  Adverse Employment Action Employee Grievance
DOA 15805  Condition of Employment - Employee Grievance Report
USCIS I-9 Form  Employment Eligibility Verification 
5.3-4-R Form  Physical Readiness Test Results 5.3-4-R
DMA Form Employee Work Rule Receipt **Please review the links below for WHRH Chapters 408 and 410 prior to signing the Employee Work Rule 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

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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