Forms for City Employees

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• Address Change Form (PDF)
• Americans with Disabilities Act (ADA)
  • ADA Physician Certification Form (PDF)
  • ADA Reasonable Accommodation Request Form (PDF)
• Annual Physical-Wellness Form (PDF)
• Catastrophic Leave Bank
  • Catastrophic Leave Bank Program (PDF)
  • Catastrophic Leave Bank Enrollment Form (PDF) 
  • Catastrophic Leave Bank Physician Certification Form (PDF)
  • Catastrophic Leave Bank Request Form (PDF) 
• City of Little Rock Employee Code of Conduct Policy (PDF)
• Classification
  
  • Classification Review Request Form-HR2A (PDF)
  • Position Analysis Questionnaire (WORD)
• Defined Benefit Plan Retirement Estimator  (EXCEL)
• Direct Deposit Form (PDF)
• Disciplinary Action Appeal Hearing Procedure Manual (PDF)
• Disciplinary Action Appeal Hearing Request (PDF)
• Employee Notification System (PDF)
• Employee Recognition
  
  • Employee Recognition Program (PDF)
  • Employee of the Year Nomination Form (PDF)
• Employee Suggestion Form (PDF)
• Electronic Communication Policy (PDF)
• Employee Email from Home (PDF)
• Flexible Spending Account (Consolidated Admin Services)
  • Medical Claim Form (PDF)
  • Dependent Care Claim Form (PDF)
• Grievance Form (PDF) 
• Independent Contractor
  • Employee vs. Independent Contractor Procedure Guideline (PDF)
  • Independent Contractor Determination Form (WORD)
• Jim Dailey Fitness Center Voluntary Deduction Form (PDF)
• Leave Request Form (PDF)
• Overtime Pre-Approval Form (PDF) 
• Performance Feedback Appeal Form (PDF)
• Religious Reasonable Accommodation Request Form (PDF)
• Residency Incentive Program Application (PDF)
• Short-Term Disability Leave Request Form (PDF)
• Supervisory Equivalent Training (SET) Program Completion List (PDF) (EXCEL) 
• Tobacco Attestation Form (PDF)
• Termination Guideline (PDF)
  
  • Resignation Letter (DOC)
  • Non-uniform Defined Benefit Retirement Application (DOC)
  • Continuation of Benefits Coverage Form (DOC)
  • Non-uniform Defined Benefit Distribution Form (DOC)
  • Termination Clearance Form (PDF)
  • Employee Exit Interview Form (DOC)
• Time Sheet (EXCEL)
• Tuition Aid Application (PDF)
• Vendor Request Form (PDF)
• W-2 Reprint Request (PDF)

Forms for Supervisors

• Background Questionnaires
  • City Applicant (PDF)
  • City Volunteer (PDF)
  • City Volunteer - Special Events (PDF)
  • Firefighter (DOC)
• Disciplinary Action Forms
  • Demotion Form (PDF)
  • Oral Reprimand Form (PDF)
  • Pre-Termination Hearing Notice (PDF)
  • Suspension Form (PDF)
  • Termination Form (PDF)
  • Written Reprimand Form (PDF)
• Drug Testing Forms
  • Baptist Health Authorization Form (PDF)
  • Reasonable Suspicion Training List (EXCEL)
  • Reasonable Suspicion Documentation Form (PDF)
• Employee Assistance Program (EAP) Mandated Referral Form (PDF)
• Family Medical Leave (Dept of Labor forms)
  • Certification of Qualifying Exigency for Military Family Leave - WH-384 (PDF)
  • Certification for Serious Injury or Illness of Covered Service member - WH-385 (PDF)
  • Designation Notice - WH-382 (PDF)
  • Employee's Serious Health Condition - WH-380-E (PDF)
  • Employee Rights and Responsibilities (PDF)
  • Family Member's Serious Health Condition - WH-380-F (PDF)
  • Notes of Eligibility and Rights and Responsibilities - WH-381 (PDF)
• FLSA Questionnaire for Non-Exempt Employees (PDF)
• Merit Pay Information
  • Merit Increase Rating Form (PDF) (DOC)
  • Merit Increase Rating Source Notification (PDF) (DOC)
  • Merit Pay Plan - June 2009 (PDF)
  • Merit Pay Procedure Briefing - October 2009 (PDF)
  • Work Plan Goals and Objectives Planning (PDF) (DOC)
  • Work Plan Goals and Objectives Rating Form (PDF) (DOC)
• Performance Evaluation Forms
  
  • Mid Year Review Form (PDF) (DOC)
  • Performance Evaluation Form (EXCEL)
  • Performance Feedback - Non-Supervisor/Non-Management (PDF)
  • Performance Feedback - Supervisor/Management (PDF)
  • Probationary Performance Evaluation Form (PDF)
• Status Change/Request for Personnel (PDF)
• Vehicle Out of Town Request (PDF)
• Violence in the Workplace (PDF)
• Workers' Compensation Forms
  
  • Authorized Medical Facilities for Work Related Injuries (PDF)
  • Form N - Employee's Notice of Injury (please print double sided) (PDF)
  • Modified Duty Form (PDF) 
  • Supervisor's Accident Report (PDF)