Forms

Accountability & Competency
Evaluation System (ACES)
Format: Adobe Format: Word
2018 ACE Form   Download 2018 ACE Form - Microsoft Word Document
ACE Form for Managers   Download ACES Forms for Managers - Microsoft Word Document
ACE Form for Executives   Download ACES Forms for Executives - Microsoft Word Document
ACE Employee Input Form - Questionnaire   Download ACES Employee Input Form - Questionnaire - Microsoft Word Document
ACE Employee Input Form - Optional Forms   Download ACES Employee Input Form - Optional Forms - Microsoft Word Document
ACES for Employees Guide Download ACES 2.0 for Employees Guide - Adobe PDF  
Benefits Claim Forms Format: Adobe Format: Word
HRA & FSA Claim Form Download HRA & FSA Claim Form - Adobe PDF  
Accident Insurance Download Accident Insurance - Adobe PDF  
Dependent Spending Account Recurring Claim Form Download Dependent Spending Account Recurring Claim Form - Adobe PDF  
Hospital Indemnity Download Hospital Indemnity - Adobe PDF  
Health Claim Form Download Health Claim Form - Adobe PDF  
Preventive Medications Claim Form Download Preventive Medications Claim Form - Adobe PDF  
Short Term Disability Download Short Term Disability - Adobe PDF  
Vision Download Vision - Adobe PDF  
Deductible Verification Form Download Deductible Verification Form - Adobe PDF  
Employee Forms Format: Adobe Format: Word
Reduced Tuition Form    
Electronic First Report of Injury (Web-only Form)    
Reasonable Accommodation Request Form Download Reasonable Accommodation Request Form - Adobe PDF Download Reasonable Accommodation Request Form - Microsoft Word Document
Outside Employment Download Outside Employment - Adobe PDF  
Request for an Alternative Work Schedule Download Request for an Alternative Work Schedule - Adobe PDF Download Request for an Alternative Work Schedule< - Microsoft Word Document
State of SD Release and Waiver - Employment Reference Release Download State of SD Release and Waiver - Employment Reference Release - Adobe PDF  
Conflict of Interest Waiver Instructions and Form Download Conflict of Interest Waiver Instructions and Form - Adobe PDF  
Conflict of Interest Matrix Download Conflict of Interest Matrix - Adobe PDF  
Family and Medical Leave Act Forms Format: Adobe Format: Word
Family and Medical Leave Request Download Family and Medical Leave Request - Adobe PDF  
FMLA Certification of Health Care Provider for Employee's Serious Health Condition Download FMLA Certification of Health Care Provider for Employee's Serious Health Condition - Adobe PDF Download FMLA Certification of Health Care Provider for Employee's Serious Health Condition - Microsoft Word Document
FMLA Medical Certification of Health Care Provider for Family Member's Serious Health Condition Download FMLA Medical Certification of Health Care Provider for Family Member's Serious Health Condition - Adobe PDF Download FMLA Medical Certification of Health Care Provider for Family Member's Serious Health Condition - Microsoft Word Document
FMLA Medical Certification of Health Care Provider for Family Member's Serious Health Condition Download FMLA Medical Certification of Health Care Provider for Family Member's Serious Health Condition - Adobe PDF Download FMLA Medical Certification of Health Care Provider for Family Member's Serious Health Condition - Microsoft Word Document
FMLA Certification of Qualifying Exigency for Military Family Leave Download FMLA Certification of Qualifying Exigency for Military Family Leave - Adobe PDF  
FMLA Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave Download FMLA Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave - Adobe PDF Download FMLA Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave - Microsoft Word Document
Health and Flexible Benefits Format: Adobe Format: Word
FY19 Decision Guide Download FY19 Decision Guide - Adobe PDF  
FY18 Decision Guide Download FY18 Decision Guide - Adobe PDF  
HSA Payroll Deduction Form Download HSA Payroll Deduction Form - Adobe PDF  
Family Status Change Form Download Family Status Change Form - Adobe PDF  
Incapacitated Dependent Child Form Download Incapacitated Dependent Child Form - Adobe PDF  
Student Verification Form Download Student Verification Form - Adobe PDF  
Tobacco Use Election Form Download Tobacco Use Election Form - Adobe PDF  
Second Level Appeal External Review Form Download Second Level Appeal External Review Form - Adobe PDF  
External Review Experimental Review Form Download External Review Experimental Review Form - Adobe PDF  
External Review Expedited Review Form Download External Review Expedited Review Form - Adobe PDF  
New Health Insurance Marketplace Coverage Options and Your Health Coverage Download New Health Insurance Marketplace Coverage Options and Your Health Coverage - Adobe PDF  
How To Guides Format: Adobe Format: Word
ACES for Employees Guide Download ACES for Employees Guide - Adobe PDF  
Employee Space Quick Reference Guide Download Employee Space Quick Reference Guide - Adobe PDF  
Manager Space Quick Reference Guide Download Manager Space Quick Reference Guide - Adobe PDF  
Manager Space Disposition Quick Reference Guide Download Manager Space Disposition Quick Reference Guide - Adobe PDF  
Proxy Management Quick Reference Guide Download Proxy Management Quick Reference Guide - Adobe PDF  
Tobacco Free Q&A Download Tobacco Free Q&A - Adobe PDF  
Life Insurance Format: Adobe Format: Word
Life/Beneficiary Electronic Enrollment Form    
Life Enrollment Form Download Life Enrollment Form - Adobe PDF  
Evidence of Insurability Instructions Download Evidence of Insurability Instructions - Adobe PDF  
Evidence of Insurability Form Download Evidence of Insurability Form - Adobe PDF  
Other Benefits Forms Format: Adobe Format: Word
FY19 Enrollment Factsheet Download FY19 Enrollment Factsheet - Adobe PDF  
FY18 Enrollment Factsheet Download FY18 Enrollment Factsheet - Adobe PDF  
Confirmation Statement/Current Coverage    
Pre-authorization Listing Download Pre-authorization Listing - Adobe PDF  
Pharmacy Format: Adobe Format: Word
CVS Participating Pharmacies Download CVS Participating Pharmacies - Adobe PDF  
Prescription Formulary (drug list) Download Prescription Formulary - Adobe PDF  
Preventive Formulary List (High Deductible Health Plan compatible) Download Preventive Formulary List - Adobe PDF  
Advanced Control Formulary (Effective April 1, 2018) Download Advanced Control Formulary - Adobe PDF  
Pharmacy Claim Form Download Pharmacy Claim Form - Adobe PDF  
Listing of Prescriptions Not Covered Under Pharmacy Download Listing of Prescriptions Not Covered Under Pharmacy - Adobe PDF  
Payroll Format: Adobe Format: Word
Direct Deposit Form Download Direct Deposit Form - Adobe PDF  
Request to Receive Donated Leave Download Request to Receive Donated Leave - Adobe PDF  
Request for an Alternative Work Schedule Download Request for an Alternative Work Schedule - Adobe PDF Download Reasonable Accommodation Request Form - Microsoft Word Document
Reclassification Forms Format: Adobe Format: Word
Position Description Questionnaire (PDQ) Employees Section Download Position Description Questionnaire (PDQ) Employees Section - Adobe PDF Download Position Description Questionnaire (PDQ) Employees Section - Microsoft Word Document
Position Description Questionnaire (PDQ) Supervisor's Section Download Position Description Questionnaire (PDQ) Supervisor's Section - Adobe PDF Download Position Description Questionnaire (PDQ) Supervisor's Section - Microsoft Word Document
Position Description Questionnaire (PDQ) Additional Duties Download Position Description Questionnaire (PDQ) Additional Duties - Adobe PDF Download Position Description Questionnaire (PDQ) Additional Duties - Microsoft Word Document
Career Band Questionnaires (CBQs) (List by Career Families)    
Seasonal/Temporary Format: Adobe Format: Word
Seasonal/Temporary Job Application Download Seasonal/Temporary Job Application - Adobe PDF  
Supervisor Forms Format: Adobe Format: Word
Selection Process Guidelines Download Selection Process Guidelines - Adobe PDF  
Competency Based Selection
Initial Interview Form I   Download Initial Interview Form I - Microsoft Word Document
Final Interview: Form F1   Download Final Interview: Form F1 - Microsoft Word Document
Final Interview: Form F2   Download Final Interview: Form F2 - Microsoft Word Document
Reference Check: Form R1   Download Reference Check: Form R1 - Microsoft Word Document
Reference Check: Form R2   Download Reference Check: Form R2 - Microsoft Word Document
Verification of Education & Experience: Form V   Download Verification of Education & Experience: Form V - Microsoft Word Document
Decision Justification: Form D   Download Decision Justification: Form D - Microsoft Word Document
Authorization for Release of Information Download Authorization for Release of Information - Adobe PDF  
Pay Increase Request Forms
Pay Increase Request Form Download Pay Increase Request Form - Adobe PDF  
Promotional Pay Request Form Download Promotional Pay Request Form - Adobe PDF  
New Hire Request over 25% of range Download New Hire Request over 25% of range - Adobe PDF  
Reference Check Forms
Option 1: Employer Reference Check Form Download Option 1: Employer Reference Check Form - Adobe PDF  
Option 2: General Reference Check Form Download Option 2: General Reference Check Form - Adobe PDF  
Requisition Request   Download Requisition Request - Microsoft Word Document
Risk Management Training Form Download Risk Management Training Form - Adobe PDF  
Volunteer Agreement Download Volunteer Agreement - Adobe PDF  
Workers' Comp Format: Adobe Format: Word
Contacts and Resources Download Contacts and Resources - Adobe PDF  
Electronic First Report of Injury    
Workers' Compensation Direct Deposit Form Download Workers' Compensation Direct Deposit Form - Adobe PDF  
Workers' Compensation Claim Procedures Download Workers' Compensation Claim Procedures - Adobe PDF  
Workers' Compensation Program Sick and Vacation Leave Form Download Workers' Compensation Program Sick and Vacation Leave Form - Adobe PDF  
Authorization for Use and Disclosure of Health Information Form Download Authorization for Use and Disclosure of Health Information Form - Adobe PDF