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