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 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)
