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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.

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

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
HR Forms (For Internal use Only)
Paid Sick Leave Ordinance Designated Person Form

Employee Handbook 2012
Retiree Health Charter Amendment
Annual Salary Ordinance
Oath of Office (PDF)
Change of Address (Word)
Collective Bargaining Agreements
Compensation Manual (PDF)
Domestic Violence Liaison Flyer (PDF)
Medical History Form (Word)
Performance Plan and Appraisal Report (PPAR) (Word) 
Performance Plan and Appraisal Report (PPAR) (PDF)
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 and Leave Protections (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

Request for Leave and Leave Protections (PDF)

FML1: Notice of Eligibility, Rights and Responsibilities (PDF)

FML2: Certification of Healthcare Provider Form (PDF)

FML3: Notice of Determination (PDF)

FML4: Leave Expiration Notice (PDF)

FML5: Key Employee Notification (PDF)

WH-385: Certification of Serious Illness or Injury - Current Service Member (PDF)

WH-385-V: Certification of Serious Illness or Injury - Veteran (PDF)

WH-384: Certification of Qualifying Exigency (PDF)


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) 
Employer's Report of Occupational Injury or Illness Form - English (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: 7/23/2015 9:13:10 AM