Attendance and Leave Forms


Attendance and Leave

If you would like more information, please contact Consultation & Accountability:

Carrie Hughes, Personnel Analyst; cphughes@admin.nv.gov or (775) 684-0111

Form Title Revision Date
Sick Leave Documentation- GINA Warning NPD-82 (Word)
Sick Leave Documentation- GINA Warning NPD-82 (PDF)
7/2011
FMLA Leave of Absence Form NPD-60 (Word)
FMLA Leave of Absence Form NPD-60 (PDF)
6/2023
FMLA Notice of Eligibility and Rights & Responsibilities NPD-62 (Word) 
FMLA Notice of Eligibility and Rights & Responsibilities NPD-62 (PDF)
9/2018
FMLA Designation Form NPD-63 (Word)
FMLA Designation Form NPD-63 (PDF)
9/2018
FMLA Medical Release NPD-81 (Word) 
FMLA Medical Release NPD-81 (PDF)
7/2015
FMLA Medical Certification for Employee WH-380-E (PDF) 1/2011
FMLA Medical Certification for Family Member WH-380-F (PDF) 5/2015
FMLA Certification of Qualifying Exigency for Military Family Leave WH-384 (PDF) 2/2013
FMLA Certification for Serious Injury or Illness of a VETERAN for Military Caregiver Leave WH-385-V (PDF) 5/2015
FMLA Certification for Serious Injury or Illness of a CURRENT service member for Military Family Leave WH-385 (PDF) 5/2015
FMLA Help for Health Care Providers flyer (PDF) 8/1/2023
Request to Receive Catastrophic Leave Donations PAY-23 (Word)
Request to Receive Catastrophic Leave Donations PAY-23 (PDF)
1/2016
Notification of Agency's Payroll Center (Regarding a Request to Use Catastrophic Leave) PAY-23A (Word) 
Notification of Agency's Payroll Center (Regarding a Request to Use Catastrophic Leave) PAY-23A (PDF)
6/8/2010
(Catastrophic) Notice of Intent to Donate/Request to Transfer Leave/Return of Excess Donated Leave NPD-25 (Word)
(Catastrophic) Notice of Intent to Donate/Request to Transfer Leave/Return of Excess Donated Leave NPD-25 (PDF)
11/2012
Physician's Certification for Catastrophic Leave Request - EMPLOYEE PAY-23CE (Word) 
Physician's Certification for Catastrophic Leave Request - EMPLOYEE PAY-23CE (PDF)
1/2016
Physician's Certification for Catastrophic Leave Request - IMMEDIATE FAMILY MEMBER PAY-23CF (Word) 
Physician's Certification for Catastrophic Leave Request - IMMEDIATE FAMILY MEMBER PAY-23CF (PDF)
1/2016
Formal Appeal to Committee on Catastrophic Leave PAY-23B (Word) 
Formal Appeal to Committee on Catastrophic Leave PAY-23B (PDF)
1/2015
Voluntary Leave Without Pay Authorized Pursuant to NAC 284.580 TS-12 (Word) 
Voluntary Leave Without Pay Authorized Pursuant to NAC 284.580 TS-12 (PDF)
2/2013
Differential Pay for Active Military Duty Policy & Procedures ML-1-3 (Word)
Differential Pay for Active Military Duty Policy & Procedures ML-1-3 (PDF)
11/2012
Calculation of Military Differential Pay ML-4 (Word)
Calculation of Military Differential Pay ML-4 (PDF)
3/2011
Shift Trade Agreement TS-133 (Word)
Shift Trade Agreement TS-133 (PDF)
8/2002
Paid Family Leave - Request HR-16 (Word)
Paid Family Leave - Request HR-16 (PDF)
1/2024
Paid Family Leave - Immediate Family Medical Certificate HR-17 (Word)
Paid Family Leave - Immediate Family Medical Certificate HR-17 (PDF)
1/2024
Paid Family Leave - Employee Medical Certificate HR-18 (Word)
Paid Family Leave - Employee Medical Certificate HR-18 (PDF)
1/2024