Forms

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ADA

Title	Date Posted
ADA Employee Request Form	06/20/2019
ADA Medical Questionnaire	10/26/2022

Criminal Background Check

Title	Date Posted
Criminal Background Check Consent	09/20/2022

Discipline

Title	Date Posted
Notice of Disciplinary Action	05/31/2024
Disciplinary Action Violation Templates

Discrimination/Harassment

Title	Date Posted
DFA Discrimination and Sexual Harassment Complaint	12/30/2024

Ethics and Fraud

Title	Date Posted
Code of Ethics Attachment B – Annual Acknowledgement	10/16/2018
Code of Ethics Attachment C – Complaint	10/16/2018

FMLA

Title	Date Posted
Employee Rights and Responsibilities Poster	11/02/2020
Family Medical Leave Request	02/17/2021
Healthcare Provider for Employee Serious Health Condition	03/21/2024
Healthcare Provider for Family Member Serious Health Condition	03/21/2024
Notice of Eligibility and Rights and Responsibilities	03/21/2024
Designation Notice	03/21/2024
Certification of Qualifying Exigency for Military Family Leave	03/21/2024
Serious Injury or Illness of a Current Servicemember – for Military Family Leave	03/21/2024
Serious Injury or Illness of a Veteran for Military Caregiver Leave	03/21/2024

Workforce Issues and Grievances

Title	Date Posted
Dispute Resolution Form	10/16/2018
Employee Workforce Issues	03/12/2025

Payroll/Time/Leave

Title	Date Posted
Display Absence Quota Instructions	10/16/2018
Address Change	10/28/2022
Bank Details – Direct Deposit	10/16/2018
Direct Deposit Hardship Exemption Request	05/19/2021
Leave Balance Quota Correction	09/30/2021
Leave Balances for Transferring Employees	10/28/2022
Leave Payout Authorization	09/30/2021
Quota Overview Instructions	10/16/2018
Sick Leave Incentive Program Notice	10/16/2018
Supervisory Leave	10/16/2018
Requested for Approved Leave Without Pay	08/14/2023
Request to Stop Miscellaneous Deductions	10/28/2022
State Withholding Certificate	02/13/2025
Federal Employee’s Withholding Certificate	02/13/2025

Personnel/Hiring

Title	Date Posted
DFA Performance Evaluation Appeal Form	06/13/2024
Employee Disclosure/Certification and Employment of Family Members Forms	10/04/2023
Emergency Hire Request	10/16/2018
Employee Master Data	08/09/2019
Financial Obligation Policy Receipt	07/22/2019
Hiring Freeze Exception Request	07/28/2023
I9 – Employment Eligibility and Verification	04/14/2025
I9 – Employment Eligibility and Verification Instructions	04/14/2025
Internal Advertising Approval Request	10/16/2018
JVR	12/03/2020
Mandatory Direct Deposit Notification	10/16/2018
New Hire Document Checklist	04/14/2025
Position Crossgrade Downgrade	09/22/2020
Proof of Prior Service	04/07/2022
Reference Consent and Release	09/15/2022
State Employee ID Voucher	10/16/2018

Remote Work

Title	Date Posted
DFA Remote Work Agreement	07/05/2023
Job Aid – Alternative Work Site Requirements (IRS Pub. 1075)	07/05/2023

Special Entry Rates

Title	Date Posted
Exceptionally Well Qualified – Special Entry Rate	10/16/2018
Movement of Current Employees to Approved Special Entry Rates	10/16/2018
New Labor Market Rates	10/16/2018
Labor Market Conditions	10/16/2018

Termination

Title	Date Posted
Change In Employment Status	04/20/2021
Separation Memo	10/27/2022

Travel

Title	Date Posted
TR-1	10/16/2018
Travel Authorization	04/24/2023

Vehicle Safety

Title	Date Posted
Title	Posted
VSP-1	01/10/2023

Workers Comp

Title	Date Posted
Workers’ Compensation Incident Report	10/16/2018
DFA Alcoholic Beverage Control Company Nurse Poster	09/23/2024
DFA Arkansas Lottery Company Nurse Poster	09/23/2024
DFA Assessment Coordination Company Nurse Poster	09/23/2024
DFA Child Support Enforcement Company Nurse Poster	09/23/2024
DFA Driver Services Company Nurse Poster	09/23/2024
DFA Medical Marijuana Comm Company Nurse Poster	09/23/2024
DFA Motor Vehicle Company Nurse Poster	09/23/2024
DFA Revenue Services Company Nurse Poster	09/23/2024
DFA Racing Commission Company Nurse Poster	09/23/2024
DFA Company Nurse Poster	09/23/2024
Workers’ Compensation Procedures	09/23/2024