Forms
Department of Civil Service Forms | Civil Service Commission Forms
Selected health insurance forms are available in NYSHIP Online under either the Employees or Retirees tab.
Physical and Medical Requirement forms are available under Employee Health Service.
| Form Title | Word Template | |
|---|---|---|
| 55 b/c Appointment Request Form | S-90.pdf | S-90.dotx |
| Authorization for Disability Record | T-252.pdf | |
| Authorization for Verification of Non-Disabled Veteran Credits Use | T-252a.pdf | |
| Candidate Disqualification Request Form | ADM-155.pdf | |
| Canvass Letter-Eligible List | S-60.pdf | S-60.dotx |
| Canvass Letter-Eligible List (Page 2 ONLY) | S-60.page2.pdf | |
| Canvass Letter-Reemployment List | S-61.pdf | S-61.dot |
| Canvass Letter-Redeployment List | S-62.pdf | S-62.dot |
| Canvass Letter-ARTLs | S-63.pdf | S-63.dot |
| Confirmation of Declination-Regular Eligible List | S-64.pdf | S-64.dot |
| Confirmation of declination-ARTLs | S-65.pdf | S-65.dot |
| Confirmation of Declination-Reemployment List | S-66.pdf | S-66.dot |
| Disability Record Authorization | S-7.pdf | S-7.dotx |
| Disposition of Veterans Credits | S-203.pdf | |
| Employee Application for Change in Title or Salary | CC-2E.pdf | |
| Existing Position Description (CC-3) | CC-3.pdf | |
| Evaluations of Foreign Education | S-916.pdf | |
| HIPAA Privacy Complaint | ADM-302.pdf | |
| Medical Examination, Agency Request for | EHS-707.pdf | |
| Medical Information, Authorization for Release and Disclosure of | EHS-742.pdf | |
| Medical Information, Authorization for Drug/Alcohol Testing and Release of | EHS-752.pdf | |
| Medical Information to a State Agency, Authorization for Release and Disclosure of | EHS-742-4.pdf | |
| Occupational Health Examinations, Agency Request for | EHS-699.pdf | |
| Preplacement Physical Examination Request | EHS-769.pdf | EHS-769.dot |
| Reinstatement Examination Request | EHS-705.pdf | |
| Request for Eligible List Status Change | S-211.pdf | S-211.dotx |
| Request to Change Individual Status on Interdepartmental Promotion Eligible Lists | S-211.1.pdf | S-211.1.dotx |
| Request for Reconstructed Seniority Date Under Section 80.3 or 80a.3 | S-202.pdf | S-202.dotx |
| Request for Reinstatement | S-46.pdf | S-46.dotx |
| Respirator certification pursuant to OSHA standards | EHS-701.8.pdf | |
| Workers with Disabilities Program Application Packet (55-b program) | Application Packet | Application Packet |
| Veterans with Disabilities Program Application Packet (55-c program) |
| Form Title | Word Template | |
|---|---|---|
| Section 211 Application, Pension Waiver Pursuant to Section 211 of the New York State Retirement and Social Security Law | CSC-1.pdf | CSC-1.dotx |
| Leave of Absence Extension | CSC-2.pdf | CSC-2.dotx |
| Civil Service Commission Appeal Form | CSC-3.pdf | CSC-3.dotx |