DHR Forms

HR Directors: Need forms related to hiring, performance management or termination? Visit the HR University page.

BENEFITS FORMS

COMPENSATION FORMS

PERFORMANCE FORMS

RISK FORMS


Benefits Forms

 Dental

  • Delta Dental Claim Form  – (PDF)

​Dependent Tax Status Information

  • Affidavit of Same-Gender Domestic Partnership – (PDF)
  • Termination of Same-Gender Domestic Partnership Affidavit – (PDF)
  • Affidavit of Common Law Marriage– (PDF)
  • Instructions for Benefits Eligibility Determination Appeals– (PDF)

Disability

  • Medical History Statement for Long-Term Disability – (PDF)
  • Standard Insurance Short-Term Disability Claim – (PDF)
  • Short-Term Disability (STD) Certificate of Coverage – (PDF)
  • Long-Term Disability (LTD) Certificate of Coverage – (PDF)
  • FY 2013-14 Long-Term Disability Premiums – (PDF)

Flexible Spending Accounts (FSAs)

  • FSA Claim Form – Online 
  • FSA Email Notification Authorization Form – (PDF)

Flexible Work Arrangements

  • Flexible Work Arrangements Executive Order - (PDF)
  • Flexible Work Arrangements Introduction - (PDF)
  • Flexible Work Arrangements Definitions - (PDF)
  • Flexible Work Arrangements FAQ's - (PDF) 
  • Flexible Work Arrangements Managing Employees - (PDF
  • Flexible Work Arrangements Sample Policy - (PDF)
  • Flexible Work Arrangements Employee Self Assessment – (PDF)
  • Flexible Work Arrangements Supervisor/Manager Self Assessment – (PDF
  • Flexplace Agreement – (PDF)  
  • Flexplace Application– (PDF)  
  • Flexplace Alternate Office Ergonomic Checklist– (PDF)  
  • Flexplace Alternate Office Safety Checklist– (PDF)
  • Flexplace Under Flexible Work Arrangements - (PDF
  • Flexplace Employee Application and Agreement– (PDF)
  • Flexplace Employee Status and Interim Evaluation– (PDF)  
  • Flextime Application and Agreement - (PDF)  
  • Flextime Under Flexible Work Arrangements - (PDF)
  • Job Sharing Request Form - (PDF)
  • Job Sharing - (PDF)
  • Job Sharing Under Flexible Work Arrangements - (PDF)

HIPAA       

  • HIPAA Authorization Form

Life Insurance

  • FY 2013-14 Optional Life Premiums – (PDF)
  • Life & AD&D Insurance Enrollment & Change Form - (PDF

Public Employees' Retirement Association (PERA)

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Compensation Forms

  • 2013 Calendar Year Holidays - (PDF)
  • 2013-14 Fiscal Calendar Year Holidays - (PDF)
  • ADS Security Access Form - (PDF)
  • Affirmative Action Form - (PDF)
  • Americas with Disabilities Act (ADAAA) - (PDF)
  • Amendment 41 Impact - (PDF)
  • Anti-Harassment Policy - (PDF)
  • Cost Savings Idea Application - (PDF)
  • Creating a Balanced Work Environment - (PDF)
  • Division of Human Resources - (PDF)
  • Employee Handbook - (PDF)
  • Equal Pay Policy - (PDF)
  • Executive Order Workplace Violence (D02309) - (PDF)
  • Executive Orders and Policies for the State Personnel System - (PDF)
  • FLSA Fact Sheet - (PDF)
  • Impairment in the Workplace - (PDF)
  • Job Classification Glossary - (PDF)
  • Manager Reference to Compensation Decisions - (PDF)
  • Non-Discrimination Policy - (PDF)
  • State of Colorado Position Description - (DOC
  • Position Description for Temporary Aide - (DOC)
  • Sexual Harassment Policy - (PDF)
  • Total Compensation Timeline - (PDF)
  • Universal Workplace Violence Policy - (PDF)
  • Universal Recruitment Policy - (PDF)
  • Work-life FAQ's - (PDF)
  • Work-life Program - (PDF)

Leave and Family Medical Leave

  • Accommodations for Nursing Mothers - (PDF)
  • FMLA Know Your Rights and Responsibilities - (PDF)
  • Leave FAQ's - (PDF)
  • FMLA Poster English - (PDF)
  • FMLA Poster Spanish - (PDF)
  • FMLA Medical Certification Form – (PDF)
  • FMLA Medical Certification Form Spanish - (PDF)
  • FMLA Medical Certification Form Family – (PDF)
  • FMLA Certification of Qualifying Exigency for Military Family Leave – (PDF)
  • FMLA Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave – (PDF)
  • FMLA Designation Notice – (PDF)
  • FMLA Notice of Eligibility and Rights and Responsibilities – (PDF)
  • FMLA Notice of Eligibility and Rights and Responsibilities: SP – (PDF)
  • Leave of Absence Request/Authorization - (PDF)
  • Leave Employee Medical Certification Form – (PDF)
  • Leave Employee Medical Certification Form: SP – (PDF)
  • Leave Medical Non- FMLA Form - (PDF)
  • Leave GINA Safe Harbor Statements Individual - (PDF)
  • Leave GINA Safe Harbor Statements Family - (PDF)
  • State of Colorado Leave/Absence Request and Authorization - (PDF)
  • State of Colorado Fitness-To-Return Certification - (PDF)
  • Psychological Fitness for Duty Form - (PDF)
  • Psychological Fitness for Duty Chart - (PDF)
  • Universal Leave Policy - (PDF)
  • Victim Leave Affidavit - (PDF)

Payroll

  • Payroll Deduction Authorization Form – (PDF)
  • Payroll Deduction Application - (PDF)

Personal Services Contracts 

  • Personal Services Contracts Certification for Personal Services Agreement– (PDF)
  • Personal Services Contracts Codes– (PDF)
  • Personal Services Contracts Cost Comparison Work Sheet– (PDF)
  • Personal Services Contracts Cost Comparison Instruction Sheet - (PDF)
  • Personal Services Contracts History of Privatization Program– (PDF)
  • Personal Services Contracts House Bill 93-1212– (PDF)
  • Personal Services Contracts Independent Contractor and Sole Proprietor Guidance– (PDF)
  • Personal Services Contracts Independent Contractor Provisions– (PDF)
  • Personal Services Contracts Reference Guide– (PDF)
  • Personal Services Contracts – Waivers on State Price Agreements– (PDF)

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Performance Forms

  • Position Description Guide (PDF)
  • Position Description – (PDF)
  • Position Description for Temporary Aide – (PDF)

Performance Review

  •  Annual Performance Review - (DOC

Personnel Appeals, Disputes and Grievance Form

  • Employee Grievance Process Flow Chart - (PDF)
  • Mediation Memorandum of Agreement - (PDF) Not yet Available
  • Mediation Agreement  - (PDF) Not yet Available
  • State Personnel System Consolidated Appeal/Dispute Form - (PDF)
  • Grievance Form - (PDF)
  • Whistleblower Complaint Form - (PDF)

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Risk Management Forms

Employee Safety

  • ErgoPoint Request Form – (PDF)

State Incident Report Forms

  • Citizen Claim for Property Damage & Bodily Injury - (PDF)  
  • State Vehicle Accident Report - (PDF)
  • State Non-Automobile Incident Report - (PDF)

State Property Insurance, Loss & Liability

  • Building & Contents Form  - (PDF)
  • State Owned Report of Property/Boiler/Crime Loss – (PDF)
  • Certificate of Insurance Request Form - (PDF)

 

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