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Forms

Click on a category below to locate your form.

Employee Relations
- Discrimination Complaint Form [Word] [PDF]
- Witness Identification Form [Word] [PDF]
Flexible Reimbursement Accounts
- Account Election Form
- Direct Deposit Form
- Medical Necessity Form
- Reimbursement Request Form
Health Benefits
- Appeals Form
 - Active Employee Eligibility and Enrollment Form
- Extended Coverage/COBRA Change Request Form
- Retiree & VSDP/LTD Enrollment Form

Hiring
- Agency Hiring Request Form
- P-14 Authorization for Unit of Work Rate PDF Format MS Word Format
- Re-Employment Opportunities Pool
- Sample Release of Information Form
- Summary of the Commonwealth of Virginia's Policy on Alcohol and Other Drugs - Certificate of Receipt
Information Technology
- Internet Use Certificate of Receipt
- Registration Form for Access to DHRM's Web Applications
Performance Management
- Acknowledgement of Extraordinary Contribution
- Employee Work Profile PDF Format Word Format
- Notice of Improvement Needed/Substandard Performance PDF Format Word Format
- Physical Demands Worksheet
- Probationary Progress Review PDF Format Word Format
- Interim Evaluation Form
- Written Notice Form PDF Format | Word Format
Telework
- Sample Checklist and Employee Certification Form
- Sample Telecommuting Work Agreement