Forms

Page 1 of 2

• Application for Veterans Flag on Drivers License or Identity Card

• Caregiver Med Cert (P-33B)

  This medical certificate is to be used by employees seeking family leave to care for a spouse, child (under age 18 or 18 or older and incapable of self-care because of mental or physical disability), or parent with a “serious health condition” / “serious illness”.

• Connecticut Wartime Service Medal Application

• DD214 Form

  Military personnel records can be used for proving military service or as a valuable tool in genealogical research.

• DVA Legal Internship Application

• Employee Benefits

  Find benefits and resources for State Employees from the Office of the State Comptroller

• Employee FMLA Request

  Employees are entitled to take up to 12 work weeks of unpaid leave in a 12-month period provided they meet eligibility and reason for leave requirements.

• Employee Med Cert (P-33A)

  This medical certificate is to be used by an employee who is or will be absent for health reasons including the birth of a child.

• Employment and Examination Announcements

  Data is updated for viewing on the DAS website on Tuesdays and Thursdays. Users may not have access to or may not see the most recent changes to their record due to this schedule. Be advised all information entered by DAS is immediately available for use by HR Professionals recruiting for state jobs.

• Food Service Reservation Form

• Intent to Return to Work (FMLA-HR3)

  To be completed by the employee before taking leave under federal FMLA and/or state family/medical leave (C.G.S. 5-248a).

• Posthumous Connecticut Wartime Service Medal Application

• Request for Authorization to Release Medical Records/Health Information

• Retirement Information

  Find information and services for State Employee retirement from the Office of the State Comptroller.

• SF 180, Request Pertaining to Military Records