DHR Forms

A

• Acceptable Use Policy/Acknowledgement Statement 
• American With Disabilities Act (ADA)
  • Reasonable Accommodation Request Form (ADA) 
  • Authorization for Release of Protected Health Information Form (ADA) 
  • Healthcare Provider Questionnaire in Response to an Accommodation Request (ADA) 
  • Reasonable Accommodation Determination Form (ADA) 
• Aetna Dependent Child Coordination of Benefits Form 
• Agreement to Comply and Acknowledgment of Receipt - Benefit Eligible Employees 
• Agreement to Comply and Acknowledgment of Receipt - Casual/Seasonal or Non-Benefit Eligible Employees 
• Alternative Work Arrangement (AWA) Agreement Form 
• Annual Leave Carryover
  • Annual Leave Carryover Form 
  • Annual Leave Carryover Request Spreadsheet 
• Authorization for Release of Protected Health Information (PHI) 
• Automobile Accident Report Form 

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C

• Call-back Pay Daily Record 
• Candidate Selection Forms
  • Disclosure of Immediate Relatives Form  
  • Hiring Packet Checklist 
  • Interview Evaluation Form 
  • Reference Contact Information Form 
  • Reference Questionnaire Form 
  • Referral Action Form 
• Casual/Seasonal Employment Statement 
• Civil Union: Certification of Tax Dependent Status for a Civil Union Spouse/Children 
• Classification and Compensation
  • Classification Request Form 
  • Advanced Starting Salary Request Form 
  • Casual Seasonal Exception Request Form 
  • Dual Incumbency (DI) Request Form 
  • Hazardous Duty (HD) Pay Analysis Request Form 
  • Labor Relations Compensation Request Form 
  • Leave of Absence from Merit System Request Form 
  • Leave from Merit DHR Agency Direct Request 
  • Straight-Time Overtime (STOT) Request Form for FLSA Exempt Employees 
• Confidentiality Agreement - Internal 
• Conflict Resolution: Request for Facilitation 

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D

• Deferred Compensation: DEFER Sick and Vacation Deferral Form 457(b) or 403(b) - Fillable version 
• Deferred Compensation: Request form to Transfer Assets from Voya to Delaware Pension Office 
• Deferred Compensation: Request form to Transfer Assets from State of Delaware Legacy 403(b) Assets to Delaware Pension Office 
• Deferred Compensation: DE Special Catch Up Form 
• Deferred Compensation: State of Delaware 403(b) Plan related requests (Distributions, Rollovers, Legacy Vendor Exchanges)
• DHR Hiring Manager/Supervisor Onboarding Checklist for Silver Lake & Reads Way Locations 
• Direct Deposit Authorization Form & Instructions 
• Disclosure of Close Relative Form 
• DL- 1: Request for Donated Leave and Physician's Statement of Disability 
• DL- 2: Request to Make a Direct Donation 
• DL- 3: Application to Make a Donation to the Donated Leave Bank 
• DL- 4: Authorization to Release Information for Solicitation Purposes 
• Drug-Free Workplace Policy Statement Acknowledgment Form (Non-DLC users only) 

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E

• Employee Information Form 
• Employment Eligibility Verification (I-9/E-Verify)
  • I-9 Employment and Eligibility Form 
  • E-Verify Notice of Participation (English and Spanish) 
  • E-Verify Notice of Rights
  • IER Right to Work (English and Spanish) 

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F

• Fleet Services: Authorized Driver Designation Application 
• Fleet Services: Automobile Accident Report 
• Flexible Spending Account (FSA)
  • FSA Enrollment Form 
  • FSA Election Change Form 
  • FSA Leave of Absence Form 
  • FSA Qualified Reservist Distribution Request Form 
• Family and Medical Leave Act (FMLA)
  • FMLA General Employee Rights and Responsibilities Requirement 
  • FMLA Eligibility 
  • FMLA Designation Notice 
  • FMLA Medical Certification for Employee 
  • FMLA Certification for Exigency Leave 
  • FMLA Medical Certification for Family Member 
  • FMLA Medical Certification for Military Caregiver 
  • FMLA Certification for Veteran Caregiver 
• Frontline Leadership Program: Program Application 
• Full-Time Student Certification Form 

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H

• Health, Dental, and Vision Enrollment/Change Form 
• Highmark Delaware (BCBS): Customer Claim Form 
• Highmark Delaware (BCBS): Disabled Child Application 
• HIPAA: Form to Describe Complaint Regarding Handling of Protected Health Information 

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M

• Merit Employee Relations Board (MERB): Employee Classification Appeal Form 
• Merit Grievance Form 
• Military Serious Illness/Injury - Employee Request 
• Military Serious Illness/Injury - Employee Statement Upon Return 
• Military Serious Illness/Injury - Physician's Statement Requesting Paid Leave 

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N

• New Hire Checklist 
• New Hire Supervisor Checklist 

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O

• Oath to Support the Constitution 

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P

• Paid Volunteer Leave Request Form 
• Parental Leave Request Form 
• Pension Actuarial Form: P-1
• Pension Contributions Form: Designate or Change Beneficiary 
• Performance Plan 
• Performance Review 
• Pregnancy Related Alternate Duty Request Form 
• Pre-Tax Commuter Benefit Program: Transit/Parking Claim Form 
• Printing and Publishing: Work Order Form 

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R

• Recognition
  • Agency Recognition Plan Form
  • Delaware Award for Excellence & Commitment in State Service Nomination Form
  • Delaware Award for Heroism Nomination Form
  • GEAR P3 Trailblazer Award
  • Governor’s Team Excellence Award
• Religious Accommodation Form 
• Relocation Assistance Form 
• Respectful Workplace and Anti-Discrimination Complaint Form 
• Request to Fill Form 

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S

• Salary Request Memo for Division Director 
• Standards of Conduct Complaint Form 
• Statement of Support Form 
• Surplus Property: Excess Property Declaration Form 

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V

• Out-of-Network Services Claim Form

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W

• W-4 Federal Tax Withholding Form 
• W-4 State of Delaware Tax Withholding Form 
• Worker's Compensation: Employer's Modified Duty Availability Report 
• Worker's Compensation: Injury/Illness Report 
• Worker's Compensation: Medical Records Release Authorization 
• Worker's Compensation: Physician's Report of Worker's Compensation Injury 
• Workforce Planning - Career Development Plan 
• Workforce Planning - Communications Strategy Template 
• Workforce Planning - Knowledge and Skills Form 
• Workforce Planning Status Check - Agency Self-Assessment