CT.gov Home Current: Human Resource Division - All Forms Programs and Services Finding Services Prevention and Health Promotion Problem Gambling Recovery Advocacy and Support Agency Directories Search Department of Mental Health and Addiction Services Search the current Agency with a Keyword Filtered Topic Search All Forms Reasonable Accommodation Request (ADA) Affirmative Action Grievance (AA-100) Office of the State Comptroller Emergency Contact Retirement Designated Beneficiary (CO 931) (NOTE: Health benefit changes/question, contact Pam.Bartley@ct.gov) Career Mobility: Application (1199) Bargaining Union only Career Mobility: Guidelines Certification Assistance: Application & Guidelines (1199 Bargaining Union only) In-Service (DAS): Employee Application - Fall 2016 In-Service (NP-2 Bargaining Union-CEUI Technical): Employee Application Fall 2016 In-Service: Payroll Reimbursement (CO-17XP-PR) In-Service: Travel Authorization (CO-112) Tuition Reimbursement: Application (CO-101) Dual Employment Request (CT-HR-25) Duties Questionnaire (CT-HR-14) Release of Information Temporary Service in Higher Class (TSHC) (P-CB-1) FMLA: Employee Request (HR1) FMLA: Medical Certification-Employee (P33A) FMLA: Medical Certification-Caretaker (P33B) FMLA: Request/Intake Form WC: Filing Status & Exemption (1A) WC: Concurrent Employment Third Party Liability Form (WC211) WC: Mileage Worksheet for Medical Treatment WC: Request for Use of Accrued Leave with Worker's Compensation (WC715) WC: Verification of Medical Appointment WC (Supervisor): Accident Investigation Report (WC207-1) WC (Supervisor): First Report of Injury (WC207) Direct Deposit (CO-1040) Federal Tax (W-4) 2017 Leave Request (MHAS 3) Leave Time Donation - Managerial & Confidential Leave Time Donation -1199 Leave Time Donation - Bargaining Unit Manual Timesheet Overtime / Compensatory Time Authorization Payroll Reimbursement (CO-17XP-PR) Request for Unpaid Leave (Less than 5 Days) Request for Unpaid Leave (More than 5 Days) State Taxes (CT W-4) 2017 Timesheet Change Alternate Work Schedule (A&R Employees) Attendance Form (Addendum B) Reporting Alleged Violation of DMHAS Policy (MHAS-20) Voluntary Schedule Reduction Program (VSRP) (CT-HR-7c) Last Paycheck after Separation Retirement: Scheduling Form Retirement Designated Beneficiary (CO 931) Retirement Refund: Health Contribution (1301) Retirement Refund: Tier I, II, III and Hybrid Manager Sick Leave Bank (MSLB) - Enrollment Application Manager Sick Leave Bank (MSLB) - Application for Use Performance Evaluation Forms/PARS (Per 132) Emergency Contact Parking / Access Cards / Employee ID - Contact your Local HR Office Travel Authorization (CO-112)
