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Human Resource Forms   

Attendance/Leave
"Act of God" Leave Request Form MS Excel Document Adobe Acrobat Document
Work Schedule Form revised 10/2012 MS Word Document Word
only
Unscheduled Absenteeism Violation Form revised 5/2013 MS Word Document Word
only

Benefits
    LASERS Forms
Designation of Beneficiary PDF
Only
 Adobe Acrobat Document
Membership Registration
*Upon completion by the employee, this form must be forwarded to the Human Resources Division for certification prior to submitting it to LASERS.		 PDF
Only
 Adobe Acrobat Document
01-03 Benefit Forfeiture PDF
Only
 Adobe Acrobat Document
    Office of Group Benefits Forms
OGB Official Schedule of Premium Rates PDF
Only
 Adobe Acrobat Document
2013 Premium Conversion Enrollment/Stop Form PDF
Only
 Adobe Acrobat Document
2013 Flexible Benefits Change Form PDF
Only
 Adobe Acrobat Document
GB-01 Enrollment Change Form
Note: This form will NOT print to the Dell MFP (Scanner/Copier/Printers).
No work-around is available at this time. 		PDF
Only
 Adobe Acrobat Document
HSA Payroll Election Form PDF
Only
 Adobe Acrobat Document
Insurance Portability Law Application PDF
Only
 Adobe Acrobat Document
Life Insurance Beneficiary Change Form PDF
Only
 Adobe Acrobat Document
Life Insurance Enrollment Kit PDF
Only
 Adobe Acrobat Document

CPTP
Mandatory Training Class (by Supervisory Group) revised 11/8/2011 PDF
Only
 Adobe Acrobat Document
Mandatory Training Position Title List web page

Drug Testing
Drug Test Notice of Results Letter MS Word Document Adobe Acrobat Document
Notification of Drug Testing Period Form revised 5/2012 MS Word Document Adobe Acrobat Document
Drug Testing Sites in Louisiana revised 3/4/2013 PDF
Only		 Adobe Acrobat Document

New Hire
Conditional Offer of Employment Form revised 10/2012 MS Word Document Word
Only
New Hire Orientation Checklist revised 1/2013 MS Word Document Word
Only
SF-13 Appointment Affidavits revision 5/2003 MS Word Document Word
Only
Supervisors Orientation Checklist MS Word Document Word
Only

Performance Evaluation System - Evaluation Forms
Office of Cultural Development
Office of the Deputy Secretary
Office of Management & Finance
Office of State Library
Office of State Museum
Office of State Parks
Office of Tourism
Volunteer Louisiana

Personal Data
Change of Address MS Word Document Adobe Acrobat Document
Direct Deposit Primary Account PDF
Only
 Adobe Acrobat Document
Direct Deposit Secondary Account PDF
Only
 Adobe Acrobat Document

Personnel Action
Optional Pay Adjustment Questionnaire MS Word Document Adobe Acrobat Document
Personnel Authorization Form (301) revised 10/2012 MS Excel Document Word
Only
Permanent Status Consideration Form MS Word Document Word
Only
Career Progression Group Consideration Form MS Word Document Word
Only
Performance Adjustment Consideration Form MS Word Document Word
only

Position Description
SF3 revised 1/2007 MS Word Document Word
Only
SF3a MS Word Document Adobe Acrobat Document
SF3 Instructions MS Word Document Adobe Acrobat Document

Pre-Employment
Confidentiality of Home Address & Phone Number MS Word Document Adobe Acrobat Document
Compensation for Overtime Work MS Word Document Word
Only
Direct Deposit Primary Account PDF
Only
 Adobe Acrobat Document
Direct Deposit Secondary Account PDF
Only
 Adobe Acrobat Document
Driver History Form (DA 2054) revised 7/01/2012 PDF
Only		 Adobe Acrobat Document
I-9 Form revised 3/08/2013 PDF
Only
 Adobe Acrobat Document
Pre-Employment Checklist MS Word Document Adobe Acrobat Document
Prior State Service MS Excel Document Adobe Acrobat Document
L-4 Tax Form (Louisiana) PDF
Only
 Adobe Acrobat Document
SSA-1945 PDF
Only
 Adobe Acrobat Document
W-4 Tax Form (2013 Federal) PDF
Only
 Adobe Acrobat Document

Recruitment
Request To Fill MS Word Document Word
only
Student Employment Application MS Word Document Word
Only

Retirement
    LASERS Forms
4-05 Authorization for Direct Deposit PDF
Only
 Adobe Acrobat Document
4-4 Spousal Consent PDF
Only
 Adobe Acrobat Document
6-01 Application For Retirement
*Upon completion by the employee, this form must be forwarded to the Human Resources Division for certification prior to submitting it to LASERS.		 PDF
Only
 Adobe Acrobat Document
6-01A Application For Retirement with IBO
*Upon completion by the employee, this form must be forwarded to the Human Resources Division for certification prior to submitting it to LASERS.		 PDF
Only
 Adobe Acrobat Document
6-2 Insurance Premium Deduction Authorization
*Upon completion by the employee, this form must be forwarded to the Human Resources Division for certification prior to submitting it to LASERS.		 PDF
Only
 Adobe Acrobat Document
9-01 Application for Deferred Retirement Option Plan (DROP)
*Upon completion by the employee, this form must be forwarded to the Human Resources Division for certification prior to submitting it to LASERS.		 PDF
Only
 Adobe Acrobat Document
9-02 Certification at End of Employment
*Upon completion by the employee, this form must be forwarded to the Human Resources Division for certification prior to submitting it to LASERS.		 PDF
Only
 Adobe Acrobat Document
9-02A Certification of Continued Employment After DROP
*Upon completion by the employee, this form must be forwarded to the Human Resources Division for certification prior to submitting it to LASERS.		 PDF
Only
 Adobe Acrobat Document
    Federal Forms
W4-P (2013) PDF
Only
 Adobe Acrobat Document

Safety
Medical Release Form MS Word Document Adobe Acrobat Document
Workers Compensation Medical Authorization Form MS Word Document Adobe Acrobat Document
Vehicle Non-State Employee Rider (passenger) Indemnification Agreement MS Word Document Adobe Acrobat Document

Separation
Employee Exit Interview revised 9/2010 MS Word Document Adobe Acrobat Document
    LASERS Forms
2-01A Authorization for Direct Rollover
*Upon completion by the employee, this form must be forwarded to the Human Resources Division for certification prior to submitting it to LASERS.		 PDF
Only
 Adobe Acrobat Document
2-01 Refund of Accumulated Contributions PDF
Only
 Adobe Acrobat Document

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