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Employee Benefits
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Forms
In order to locate the form of your choice, click on a category below.
Employee Relations
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Discrimination Complaint Form
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Witness Identification Form
Employee Suggestion
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Employee Suggestion Evaluation Form
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Employee Suggestion Program Form
Flexible Reimbursement Accounts
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Account Election Form
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Direct Deposit Form
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Medical Necessity Form
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Reimbursement Request Form
Health Benefits
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Appeals Form
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Eligibility and Active Enrollment Form For Employees
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Extended Coverage Enrollment Form
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Retiree & VSDP/LTD Enrollment Form
Hiring
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Agency Hiring Request Form
PDF Format
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P-14 Authorization for Unit of Work Rate
PDF Format
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Word Format
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Re-Employment Opportunities Pool
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Sample Release of Information Form
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Summary of the Commonwealth of Virginia's Policy on Alcohol and Other Drugs - Certificate of Receipt
Information Technology
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Internet Use Certificate of Receipt
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Registration Form for Access to DHRM's Web Applications
Performance Management
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Acknowledgement of Extraordinary Contribution
- Employee Work Profile
PDF Format
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Word Format
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Notice of Improvement Needed/Substandard Performance
PDF Format
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Word Format
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Physical Demands Worksheet
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Probationary Progress Review
PDF Format
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Word Format
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Interim Evaluation Form
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Written Notice Form
PDF Format
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Word Format
Telework
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Sample Checklist and Employee Certification Form
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Sample Telecommuting Work Agreement