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NYS DMNAMNHS Home Page MNHS Forms

Employment

  DMNA Application for Employment   DMNA Form 1041

  Outside Employment    http://dmna.ny.gov/state/files/DMNA_Form_88.pdf

Personal Information/Emergency Contact

  DMNA Emergency Contact Form  DMNA Form 75

  DMNA Personal Information  DMNA Form 75-1

 

Health Benefits

  NYS Health Insurance Transaction Form (PS 404) http://www.cs.state.ny.us/forms/ps404pe.pdf

  CSEA EBF Enrollment Form  CSEA Employee Benefit Fund Enrollment Form

 Health Insurance Opt Out Program  Insurance Opt Out Form

 Health Insurance Choices  https://www.cs.state.ny.us/ebd/ebdonlinecenter/choices11/actives/actives_choices_set_11.pdf

 

Time and Attendance

DMNA Leave Form           DMNA CP7 

DMNA Request Advanced Sick Leave     DMNA CP8-1

DMNA Request Sick Leave at Half Pay    DMNA CP8

DMNA Leave Donation Form     DMNA CP9

 

Retirement

   Designation of Beneficiary http://www.osc.state.ny.us/retire/forms/rs5127.pdf

  Change of Address (Active Member) http://www.osc.state.ny.us/retire/forms/rs5512.pdf

  Application for Service Retirement http://www.osc.state.ny.us/retire/forms/rs6037.pdf?utm_source=enews-employer-july13&utm_medium=email&utm_campaign=employer-hot-topics-1

  Withdrawl of Application for Retirement http://www.osc.state.ny.us/retire/forms/rs6354.pdf

 

Payroll

  Direct Deposit Form      http://www.osc.state.ny.us/payroll/files/ac2772.pdf

  2019 NYS IT2104        https://www.tax.ny.gov/pdf/current_forms/it/it2104_fill_in.pdf

  2019 Federal W4          https://www.irs.gov/pub/irs-pdf/fw4.pdf

  Federal I9                      https://www.uscis.gov/sites/default/files/files/form/i-9.pdf

  Waiver of Additional Money for Holiday Work       Holiday Comp Waiver

 

Overtime

Overtime Bulletin - Overtime Bulletin

Overtime Form          OT Form

Lease Overtime Form     Lease OT Form

 

FMLA

  Certification of Health Care Provider for Employee’s Serious Health Condition

/state/files/1549041075--WH-380-E.pdf

  Certification of Health Care Provider for Family Member’s Serious Health Condition

/state/files/1549041094--WH-380-F.pdf

  Notification of Eligibility and Rights & Responsibilities

/state/files/1549041109--WH-381.pdf

  Designation Notice /state/files/1549041122--WH-382.pdf

  Certification of Qualifying Leave for Military Family Leave

/state/files/1549041133--WH-384.pdf

  Certification for Serious Injury or Illness of Covered Service member--For Family Medical Leave

/state/files/1549041144--WH-385.pdf

 

ADA

For questions or assistance with ADA procedures, please contact the agency ADA Coordinator, Mrs. Tina Lehning or Deputy Human Resources Director, Mrs. Laurie Romer at (518) 786-4830.

ADA Reasonable Accommodation Procedures  http://dmna.ny.gov/state/files/MNHS_Bulletin_2014-04_-_ADA_Reasonable_Accommodation_Procedures.PDF

 

Reasonable Accommodation Procedures - Public

/state/files/1509545332--Reasonable_Accommodation_Public_2017.pdf

 

Reasonable Accommodation Procedures - Disability

/state/files/1509544974--Reasonable_Accommodation_Request_Form_(Disability)_2017.pdf

 

Reasonable Accommodation Procedures - Religion

/state/files/1509544941--Reasonable_Accommodation_Request_Form_(Religion)_2017.pdf

 

Performance Evaluations

  CSEA Employee Evaluation

  M/C Employee Evaluation

 

Probationary Status Reports

  Administrative, Armory, O&M  DMNA 1033

  Firefighter  DMNA 1034

  Security  DMNA 1035

 

Workplace Violence Report

Incident Report Form http://dmna.ny.gov/state/files/DMNA27_20150123.pdf

 

Discrimination Complaint Form

https://goer.ny.gov/new-york-state-discrimination-complaint-form

 

MNFE Forms and Resources

DMNA Form 47 - (Project Request Form) - /state/files/1507296697--DMNA_47_-_17_SEP_15.pdf

DMNA Form 95 - (Hand Receipt for Expendable or Non-Expendable Items) - /state/files/1507296722--DMNA95_(002).pdf

Business Service Center (BSC) Announcements

Website: https://bsc.ogs.ny.gov/

/state/files/1548794368--1548266355--Leave_for_Childbirth_Childcare_and_Adoption_Guidelines.pdf

 

 

 

© NYS DMNA: State Resources: MNHS Forms
URL: http://dmna.ny.gov/state/?page=1300200017
Page Last Modified: 05 Feb 19
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