Unless otherwise indicated, these forms are provided in MS Office Word format. If you do not have MS Word, you can download a freeware copy of any of the Microsoft Word Viewers which are available from Microsoft. Microsoft provides detailed information with each copy of these programs including instruction for installation and use.
Documents in PDF format can only be viewed and printed by using an Adobe Acrobat Reader.
Electronic forms have to be downloaded onto your hard drive and activated from there. Using these forms may require you to do a one-time download of a 32-bit driver. Complete instructions for the download and installation, as well as suggestions on how to set up your computer files for an easier understanding of the E-form format are available on the menu to the right of this paragraph. Please read these instructions before proceeding to the software download process. REMEMBER: This MUST BE installed on the C DRIVE of your local PC.
ACE or ERA Award
Request for ACE or ERA Award (Word - 75 KB)
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Adoption Assistance Application Form - 101 KAR 2:120
Adoption Assistance Application Form (Word - 36 KB) - Use this form to request financial assistance for adoption expenses.
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Affirmative Action Program Quarterly Report
Affirmative Action Program Quarterly Report (Word - 58 KB)
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Annual Leave Sharing - 101 KAR 2:106
Annual Leave Sharing Application Form (Word - 62 KB) - This form is used by an employee who wishes to receive donated annual leave.
Annual Leave Sharing Donation Form (Word - 72 KB) - This form is used by an employee who wishes to make an annual leave donation.
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Appeal Form - 101 KAR 1:365
Appeal Form (Word - 101 KB) - All appeals to the Personnel Board must be on this form.
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Appeal Withdraw Form
Appeal Withdraw Form (PDF - 24KB) - All appeal withdraws to the Personnel Board must be on this form.
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Application Request
Application Request (PDF - 17 KB) - Use this form to request application and application up-date(s) on file.
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Authorization for Returning Retirees
Authorization for Returning Retirees replaced by Member and Employer Certification Regarding Reemployment (PDF - 17 KB)
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COS/CICS/Document Direct (Legacy) Systems Security
Click HERE to go to the Personnel Cabinet Systems Application Security webpage.
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Cooperative/Internship Education
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Direct Deposit Form
Direct Deposit Form (Word - 60 KB)
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Dual Employment
Request for Dual Employment (Word - 50 KB)
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Educational Achievement Awards
Request for Educational Achievement Awards (Word - 153 KB)
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Educational Leave Contract
Educational Leave Contract (Word - 30 KB) - Please use this form when granting leave of absence for continuing education or training.
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Employee Educational Assistance Form
Employee Educational Assistance Form (Excel - 30KB) - The program provides financial assistance to employees to continue their formal education.
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Employee Performance Evaluation - 101 KAR 2:180
New forms effective for use beginning 1/1/12:
Excel Version: (all forms contained within one document/performs math calculations)
Word Version: (all forms are separate documents/does NOT perform math calculations)
Word Version: (certain and/or all forms combined into single documents/does NOT perform math calculations)
Acknowledgement Form (Word - 44KB)
Performance Improvement Plan (Word - 42KB)
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Employee Suggestion System - 101 KAR 2:120
If you think of a way to make state work or services more efficient, more economical, or safer, you can be recognized and rewarded for your good idea by submitting it through the Employee Suggestion System using this form.
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Employee's Affidavit
Employee's Affidavit (PDF - 382 KB)
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FMLA
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First Check Loan Application Form (For New Hires Only)
First Check Loan Application Form (For New Hires Only) (PDF - 38 KB) - This application may be submitted to Kentucky Employees Credit Union (KECU).
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Fair Labor Standards Act
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Grievance Form - 101 KAR 1:375
Grievance Form (Word - 93 KB)
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Internal Mobility Form
Internal Mobility Form (PDF - 12KB)
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Kentucky Employees Charitable Campaign (KECC) Form
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Mediation - 101 KAR 2:230
Request for Mediation Form (Word - 36 KB)
Agreement to Mediate Form (PDF - 54 KB)
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Military Leave - Designation Form
Military Leave - Designation Form (Word - 103 KB)
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Off-Cycle Request Form
Off-Cycle Request Form (Word - 89 KB)
KHRIS SAS Payment Agreement (PDF - 13 KB)
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Overtime Compensation Election Form - 101 KAR 2:102
Overtime Compensation Election Form (Word - 52 KB)
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Payroll Deduction Forms
Payroll Deduction Application Introductory Letter (PDF - 28 KB) - This letter introduces those interested in applying for participation with Payroll Deduction to the application process as well as the payroll deduction service.
Payroll Deduction Application/Agreement (Word - 57 KB) - This form outlines the policies set forth by the Personnel Cabinet in regards to the Payroll Deduction service. It must be signed and returned to be considered for approval.
Certification of Authorization to Deduct Administrative and Other Charges Relating to the Cost of Payroll Deduction (Word - 60 KB) - This form authorizes the Personnel Cabinet to deduct administrative fees and other charges in return for processing payroll deductions. It must also be signed and returned to be considered for approval in the Payroll Deduction service.
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Personnel Action Exemption
Request for Personnel Action Exemption (Excel - 110 KB) - This form can be submitted by email to the Secretary of the Governor’s Executive Cabinet at paa.mailbox@ky.gov
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Position Description Worksheet
Position Description Worksheet (Excel - 77 KB)
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Position/Personnel Action Request
Position/Personnel Action Request (Excel - 465 KB) - This form is for optional internal use, except as noted on the instruction page.
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Pre-Termination Hearing Form
Pre-Termination Hearing Form (Word - 51 KB)
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Previous Qualifying Service Form
Previous Qualifying Service Certification Form (Word - 48 KB)
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Reallocation Form
Reallocation Form (Word - 55 KB)
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Records Request Forms
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Reinstatement Certification Form
Revised - Reinstatement Certification Form (Word - 42KB)
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Reinstatement Privileges Information
Reinstatement Privileges (View Only) (Word- 17.94KB)
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Request for Approval of Multilingual Premium
Request for Approval of Multilingual Premium Per 101 KAR 2:034 Section 9 (3) (Word - 85 KB)
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Request to Distribute Information via Payroll
*Only state agencies are eligible to request printing of content considered beneficial to employees.
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Safety Program Forms
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Sick Leave Sharing - 101 KAR 2:105
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Signature Authorization Form
- Signature Authorization Form (Word - 51 KB) - Agencies must notify the Personnel Cabinet of who within their agency is authorized to sign the following documents: Requests for Personnel/Position Action, Payroll Documents, Notices of Layoffs, Notices of Dismissals, Suspensions, or Disciplinary Fines, or Authorized to Represent the Appointing Authority at Personnel Board Hearings. Please send the completed form to Personnel Cabinet, Division of Employee Management, Personnel Administration Branch, State Office Building, 3rd Floor, 501 High Street, Frankfort, KY 40601
- Revoke Signature Authorization Form (Word - 48 KB) - In order for us to keep our signature files current and up-to-date, please be sure to send us notice when you have someone who leaves or is no longer authorized to sign any of the above documents. Please send the completed notice to Personnel Cabinet, Division of Employee Management, Personnel Administration Branch, State Office Building, 3rd Floor, 501 High Street, Frankfort, KY 40601.
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State Service Request Form
For Leave Accrual Purposes- Annual/Sick (Word - 86 KB) -Please use this form to request service verification or to have sick leave retained. Please send the request to Carolyn Bruce, Personnel Cabinet, Division of Employee Management, Personnel Administration Branch, State Office Building, 3rd Floor, 501 High Street, Frankfort, KY 40601 or fax to 502/564-1823.
To Confirm 16 Years Career Service (Word - 89 KB) - Please use this form to confirm career service (16 years). Please send the request to Debbie Parido, Personnel Cabinet, State Office Building, 3rd Floor, 501 High Street, Frankfort, KY 40601 or fax to 502/564-0222.
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State Employee Travel Information
State Employee Travel Information - This link will take you to the Finance and Administration Cabinet's site for the official travel regulations, reimbursement rates, travel instructions and forms.
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Voluntary Transfer/Demotion/Salary Retention Agreement Form - 101 KAR 1:335
Voluntary Transfer/Demotion/Salary Retention Agreement Form (Word - 101 KB) - The Personnel Cabinet is requiring the submission of this form with all requests for voluntary transfer/demotion in order to verify the specific action agreed to by both the agency and the employee as well as verifying that the employee has been informed of the regulations relative to retention of salary if that is the case.
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Volunteer/Intern Information
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Workers' Compensation Forms (some associated forms are incorporated by reference to 101 KAR 2:140)
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