CTMD: Agency Forms

Agency Forms
  
PC-1 Form
To download PC-1 (PDF Format)
To send this form electronically, attach it to an email to Lydia Lin
Receiving Report
To download Receiving Report (Word format)
To send this form electronically, attach it to an email to Ronna Cannata
Employee Recognition
State/Federal Employee Recognition Program Nomination Form
             
                   
Military Family Relief Fund
To download CTMD 7-1 (PDF Format)
To send this form electronically, attach it to an e-mail to Russell Bonaccorso
                 
            
Wartime Service Bonus
To download CTMD 2-1 (PDF Format)
To send this form electronically, attach it to an e-mail to Russell Bonaccorso
                 
            
Request for and-or Release of Records
To request a copy of your Connecticut National Guard Military Records, download Standard Form 180 and send it electronically to Donna Motuzick
                
            
Employee Request for FMLA (FMLA-HR-1)
For Leave of Absence under the Federal Family and Medical Leave Act (FMLA).  Send to Anthony Lewis
                
            
Intent to Return to Work (FMLA-HR-3)
To be completed prior to taking a Leave of Absence under the Federal Family and Medical Leave Act (FMLA).  Send to Anthony Lewis
                
            
Medical Certificate (P33-A Employee)
For the employee to have completed by their physician for an employee who is absent due to a personal illness.  Send to Anthony Lewis
                
            
Medical Certificate (P33-B Caregiver)
For the employee to have completed by their physician for an employee who is absent due to care for a spouse, child, or parent with a serious health condition or illness.  Send to Anthony Lewis


Content Last Modified on 12/19/2013 11:27:35 AM