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The Official Website of the State of Arkansas

Forms

Forms

NOTICE:
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ADA

TitleDate Posted
ADA Employee Request Form06/20/2019
ADA Medical Questionnaire10/26/2022

Criminal Background Check

TitleDate Posted
Criminal Background Check Consent09/20/2022

Discipline

TitleDate Posted
Notice of Disciplinary Action 08/07/2025
Disciplinary Action Violation Templates
Performance Improvement Plan (PIP)10/20/2025
Performance Improvement Plan (PIP) Results07/22/2025
Probation Period Extension10/10/2025

Discrimination/Harassment

TitleDate Posted
DFA Discrimination and Sexual Harassment Complaint12/30/2024

Ethics and Fraud

TitleDate Posted
Code of Ethics Complaint10/16/2018

Workforce Issues and Grievances

TitleDate Posted
Dispute Resolution Form10/16/2018
Employee Workforce Issues03/12/2025

Payroll/Time/Leave

TitleDate Posted
Bank Details – Direct Deposit10/16/2018
Direct Deposit Hardship Exemption Request05/19/2021
Leave Balance Quota Correction09/30/2021
Leave Balances for Transferring Employees10/28/2022
Leave Payout Authorization09/30/2021
Sick Leave Incentive Program Notice10/16/2018
Request for Approved Leave Without Pay08/14/2023
Request to Stop Miscellaneous Deductions10/28/2022

Personnel/Hiring

TitleDate Posted
DFA Performance Evaluation Appeal Form06/02/2026
Employee Relative & Financial Interest Disclosure06/01/2026
Employee Master Data08/09/2019
Financial Obligation Policy Receipt07/22/2019
Hiring Freeze/Intent to Fill Request06/23/2026
New Hire Document Checklist07/31/2026
Proof of Prior Service04/07/2022
Recruitment Intake Form09/29/2026
Reference Consent and Release09/15/2022
State Employee ID Voucher10/16/2018

Alternative Work Arrangements

TitleDate Posted
Infants at Work Request06/23/2026
Job Aid – Alternative Work Site Requirements (IRS Pub. 1075)07/05/2023
Remote Work Agreement Form03/03/2026

Termination

TitleDate Posted
Change In Employment Status04/20/2021
Separation Memo10/27/2022

Vehicle Safety

TitleDate Posted
TitlePosted
VSP-101/10/2023

Workers Comp

TitleDate Posted
Workers’ Compensation Incident Report03/04/2026
DFA Alcoholic Beverage Control Company Nurse Poster09/23/2024
DFA Arkansas Lottery Company Nurse Poster09/23/2024
DFA Assessment Coordination Company Nurse Poster09/23/2024
DFA Child Support Enforcement Company Nurse Poster09/23/2024
DFA Driver Services Company Nurse Poster09/23/2024
DFA Medical Marijuana Comm Company Nurse Poster09/23/2024
DFA Motor Vehicle Company Nurse Poster09/23/2024
DFA Revenue Services Company Nurse Poster09/23/2024
DFA Racing Commission Company Nurse Poster09/23/2024
DFA Company Nurse Poster09/23/2024
Workers’ Compensation Procedures03/04/2026