MNHS Forms

• • Contact MNHS
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  • MNHS Forms
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  • Americans with Disabilities Act (ADA)
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• • The Adjutant General’s Vision and Guidance
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• • The Service Disabled Veteran-Owned Business (SDVOB)
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Employment

• DMNA Form 1041 - DMNA Application for Employment
• Outside Employment

Personal Information/Emergency Contact

• DMNA Form 75 - Emergency Contact Form
• DMNA Form 75-1 - Personal Information

Health Benefits

• NYS Health Insurance Transaction Form (PS 404)
• CSEA Employee Benefit Fund (EBF) Enrollment Form
• Health Insurance Opt Out Program Form
• Health Insurance Choices

Time and Attendance

• DMNA CP7 Leave Form
• DMNA CP8-1 - Request Advanced Sick Leave
• DMNA CP8 - DMNA Request Sick Leave at Half Pay
• DMNA CP9 - Leave Donation Form

Retirement

• RS 5127 - Designation of Beneficiary
• Change of Address (Active Member)
• Application for Service Retirement
• Withdrawl of Application for Retirement

Payroll

• Direct Deposit Form
• NYS IT2104
• Federal W4
• Federal I9
• Holiday Comp Waiver

Overtime

• Overtime Form
• Lease Overtime Form

FMLA

• Certification of Health Care Provider for Employee’s Serious Health Condition
• Certification of Health Care Provider for Family Member’s Serious Health Condition
• Notification of Eligibility and Rights & Responsibilities
• Designation Notice
• Certification of Qualifying Leave for Military Family Leave
• Certification for Serious Injury or Illness of Covered Service member--For Family Medical Leave

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
• Reasonable Accommodation Procedures - Public
• Reasonable Accommodation Procedures - Disability
• Reasonable Accommodation Procedures - Religion

Performance Evaluations

• CSEA Employee Evaluation
• M/C Employee Evaluation

Probationary Status Reports

• DMNA 1033 - Administrative, Armory, O&M
• DMNA 1034 - Firefighter
• DMNA 1035 - Security

Workplace Violence

• Workplace Violence Incident Report Form

Discrimination

To file a complaint:

• Web fillable
• PDF fillable
• MS Word

MNFE Forms and Resources

• DMNA Form 47 - Project Request Form
• DMNA Form 95 - Hand Receipt for Expendable or Non-Expendable Items

Business Service Center (BSC) Announcements

• BSC Website: https://bsc.ogs.ny.gov/
• Leave for Childbirth, Childcare and Adoption Guidelines

© NYS DMNA: State Resources: MNHS Forms
URL: http://dmna.ny.gov/state/?page=1300200017
Page Last Modified: 25 Jan 22