Shown below are frequently used forms related to state personnel administration. A few of these forms, such as our Application are for public use. Most of the forms are used only by state government employees and state agencies. Obviously, not all personnel forms are available in electronic format. We will post other forms as these become available. You must have the free Adobe Acrobat Reader installed to view PDF documents. For information about these documents and possible problems read below.
Employment Forms
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| Application Form (See Note.) Applicants should apply online. Applicants with disabilities or other valid reasons may require a paper form. Do not use a paper application if you can apply online. [Online Application Guide] If you need help or want information about applying online, please call 304.558.3950 x57207 Go to our job opportunities page to review posted jobs and learn how to apply online. |
Download Paper Application |
| For Authorized State Agency Staff Only - Pay Plan Implementation (Password Required)
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| These forms are for authorized state agency use only. Password required. Pay Plan Implementation Guidelines -- [Fillable PDF, Password Required] [MSWord, Password Required] Pay Plan Implementation, Request for Approval Form -- [Fillable PDF, Password Required] [MSWord, Password Required] |
| Forms for Employees and State Agencies | |||
| Employee Suggestion Program (Rules and Form) | Employee Suggestion Form | ||
| Applicant Tracking Form
(landscape or portrait.)
Explanatory memo / hiring practices | Certification of Rule Compliance in Hiring (Template) |
MSWord Portrait |
WordPerfect Portrait |
PDF Portrait |
| Leave Donation Program Forms | Download | ||
| Education Expense Reimbursement Forms | See Policy page | ||
| CS-00 Report of Changes, Payroll Certification | Excel | ||
| Employee of the Month Nomination About the EOM program. |
PDF 46k | ||
| HRIS User Profile Entry Form (New) | MSWord .doc | ||
| HRIS Work Flow Form (New) | MSWord .doc | ||
| Application for Organ Donation/Testing Leave with Pay | |||
| Physician’s/Practitioner’s Statement for Organ Donation/Pre-Operative Testing | |||
| WORKERS COMPENSATION/SICK LEAVE FORMS (For these forms, "Election of Option", "Buy-back", etc. see policy DOP-P7.) |
Policy with Forms (PDF) | ||
| Reference Information Form and Reference Release Form (See policy: Employment References (DOP_P9).) |
Policy with Forms (PDF/RTF) | ||
| Secondary Employment/Certain Volunteer Activity Forms (For these forms, see policy DOP-P21.) |
Policy with Forms (PDF) | ||
| Leave of Absence With or Without Pay NOTE: Please print these forms as needed. The documents are being reformatted to enable electronic completion. | |||
| Application for Leave With Pay (DOP-L1) | Download DOP-L1 | ||
| Application for Leave Without Pay (DOP-L2) (Personal, Military or Educational only) | Download DOP-L2 | ||
| Physician's / Practitioner's Statement (DOP-L3) | Download DOP-L3 | ||
| Application for Leave of Absence for FMLA [paid or unpaid], PLA, and/or Medical Leave Without Pay (DOP-L4) | Download DOP-L4 | ||
| Supplemental Certification of Health Care Provider for Employee's Serious Health Condition (DOP-L5) [FMLA and/or Medical Leave Without Pay - Only to be used when DOP-L3 provides insufficient information.] | Download DOP-L5 | ||
| Supplemental Certification of Health Care Provider for Family Member's Serious Health Condition (DOP-L6) [FMLA and/or PLA - Only to be used when DOP-L3 provides insufficient information.] | Download DOP-L6 | ||
| Certification for a Serious Injury or Illness of a Covered Service Member (DOP-L7) [Military Caregiver FMLA Leave] | Download DOP-L7 | ||
| Certification of Qualifying Exigency for Military Family Leave (DOP-L8) | Download DOP-L8 | ||
| Notice of Eligibility and Rights and Responsibilities (DOP-L9) [Employer Notice - FMLA and/or PLA] | Download DOP-L9 | ||
| Designation Notice (DOP-L10) [Employer Notice - FMLA and/or PLA] | Download DOP-L10 | ||
| Performance Appraisal Forms (All Forms Updated: 8/1/2006) [EPA Policy] | |||
| EPA-1. For Initial Planning, Expectations Session,
or when expectations have changed. The PDF file contains all 3 forms (EPA-1, EPA-2, EPA-3). PDF files are for printing only. Data entered on the form cannot be saved. |
PDF All Forms |
EPA-1 WordPerfect |
EPA-1 MS Word |
| EPA-2. Used for interim or mid-point review. | EPA-2 WordPerfect |
EPA-2 MS Word |
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| EPA-3. Used for final review of performance period. | EPA-3 WordPerfect |
EPA-3 MS Word |
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| EPA-3 Online Worksheets.
(Not an official Employee Performance Appraisal form) These online forms can assist with EPA-3 computations. |
Employee 23 Elements |
Supervisor/Manager 37 Elements |
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| Online Training Registration (State employees only)
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| Class Registration (Online only) Training Registration Information |
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| Classification Forms (State employees
only) |
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| Position Description Form [Classification Home] |
Download | ||
| Local Health Department Staffing Request Form w/ Instructions | See Classification | ||
| Temporary Restrictions on Hiring - Guidelines and Form
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| Instructions and Guidelines for Requesting Exceptions to the Temporary Restriction on Hiring | Download Memo | ||
| Job Vacancy Posting Form | Download Form | ||
| Employee Grievance Form (Grievance Bd. Web site) |
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| Grievance Forms for State Employees |
Grievance Board Website and Forms | ||
HOME page.Other formats and possible problems....
Information about these documents and all Division of Personnel services may be accessed from our
The Division of Personnel provides some forms in WordPerfect for Windows (WPD) and/or Microsoft Word (MS Word) formats. We suggest you use the "save link as", "save target as", or "save file to disk" feature to download the form. Then, open the form in the appropriate program.
Since we cannot predict how these forms will appear or print on all computers, we cannot guarantee satisfactory results. We strongly suggest you test print these forms before entering any information. Many people experience problems when using downloaded word processor type forms. These problems are often related to font and printer differences. You may make minor adjustments to the form in order to ensure proper page printing; however, forms which have been significantly altered in format or content cannot be processed.
Note: The "Download" link shown in the format columns means that the format choices are explained on a separate form download page.