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Forms and Documents

DHR offers downloadable forms and documents in Portable Document Format (PDF) and/or MS Word (DOC) formats. PDF files require the Adobe Acrobat Reader. If you need assistance obtaining or using this reader, please read our PDF help file. If you require a document not on this list, please contact us. City employees with access to the City's intranet may find additional forms at the intranet Form Center.

Documents
General DHR Documents
Policy Memoranda from DHR (DHR Memos)
Position Count By Job Codes

Job Application Materials
Veteran's Preference Application (Word)
Americans With Disabilities Act (ADA)
Equal Employment Opportunities (EEO)
Family and Medical Leave Act (FMLA)
Health Service System
Referral Unit
Request for Leave
Workers' Compensation
HR Forms (For Internal use Only)
Paid Sick Leave Ordinance Designated Person Form

General
Employee Handbook 2012
Retiree Health Charter Amendment
Annual Salary Ordinance
Change of Address (Word)
Collective Bargaining Agreements
Compensation Manual (PDF)
Medical History Form (Word)
Performance Plan and Appraisal Report (Word)
Performance Improvement Plan (PIP) (Word)
Performance Improvement Plan (PIP) (PDF)
Request for Approval of Additional Employment (PDF)
Supervisors Guide: How to Refer Employees to the EAP (PDF)
Telecommuting: Mayoral Directive (Word)
Telecommuting: Program Guidelines & Participation Packet (PDF)
Training Enrollment Form (PDF) 
Employee Request For Reappointment (PDF)
Employee Request For Reinstatement (PDF)
Employee Request For Transfer (PDF)
Paid Parental Leave FAQs (PDF)

Classification Forms
Recommended Classification Action Form (Word)
Recommended Classification Action Form (PDF)

Request for Leave Forms
Request for Leave (PDF)

Catastrophic Leave Program
Program Information (PDF)
Application (PDF)
Donor Form (PDF)
FM Application (PDF)
FM Donor Form (PDF)

Family and Medical Leave Act (FMLA) Forms

FMLA #1:Your Rights Under FMLA (pdf)

FMLA #1A Request for Leave (pdf)

FMLA #1B Response to Employee Request for Leave (pdf)

FMLA #1C: Request for Extension Form (pdf)

FMLA Form #1E: Intermittent Leave Verification Form (pdf)

FMLA #2: Certification of Healthcare Provider Form (Word)

FMLA #3: Supervisor Report of Absence Form (Word)

FMLA #3A: Facts for Supervisors (Word)

FMLA #4: Automatic Designation Form (Word)

FMLA #5: Withdrawal of FMLA Designation (Word)

FMLA #6: Leave Expiration Notice Form (Word)

FMLA #7: Fitness for Duty Certification Form (Word)

FMLA #8: Departmental Request for Key Employee Designation (Word)

FMLA #9: Key Employee Notification of Restricted Rights of Return from FMLA Leave (Word)

FMLA Personnel Office Checklist (Word)

FMLA Employee Leave Checklist (Word)

 

Americans With Disabilities Act (ADA) Forms
Employment Rights for Persons With Disabilities (PDF)
Health Care Provider Certification Form (PDF)
Medical Authorization and Release (PDF)
Request for Reasonable Accommodation (PDF)

Health Service System Forms
Delta Dental Claim Form (PDF)
EBS Claim Form (PDF)
Flexible Spending Account Reimbursement Form (PDF)
Temporary Exempt Employee: Health Benefits Processing Form (PDF)

Referral Unit
Request for Change of Employment Availability Form (PDF)

 

Workers' Compensation
Employee's Claim for Workers' Compensation Benefits Form (PDF)
Pre-Designation of Physician Form - English (PDF)
Pre-Designation of Physician Form - Spanish (PDF) 
New Employee Guide-Workers' Compensation (PDF)
Notice to Employee - Injuries Caused By Work (PDF)

Equal Employment Opportunities
Department Report of Employment Discrimination Complaint (PDF)

HR Forms (For internal use only)

 
Last updated: 9/30/2014 9:00:22 AM