9/11 WTC Forms

WTC Disability Application for Active Members

WTC Disability Application for Retired Members


Department Forms

Annual Evaluation Guidelines

Application to Donate Leave

FAULTY VEHICLE AIR CONDITIONER

(A.F.L.) APPLICATION FOR LEAVE

MUTUAL REQUEST FORM

FDNY MEDICAL DOCUMENTATION FORM

BIOLOGICAL EXPOSURE REPORT (md-x3)

DONATED SICK LEAVE

EMPLOYEE STATEMENT FORM

LEAVE OF ABSENCE REQUEST

REASSIGNMENT REQUEST

REASONABLE ACCOMMODATION APPLICATION

REASONABLE ACCOMMODATION APPEAL

WORKER’S COMP (LODI) PACKAGE

FINANCIAL NEED

LIFE EVENTS FORMS

LEAVE OF ABSENCE REQUESTS

Domestic Partner Checklist

Newly Wed Checklist

New Born Checklist

Change of Status

Beneficiary Form

Designation of Beneficiary

Health Benefits Application

NYCERS Form 133

Enrollment Form 2011

Retirement Planning

RETIREMENT FORMS

1. Retirement Form; goes to Station Captain
    a. Go to NYCERS for eligibility of time
    b. contact F.D.N.Y.  Human Resources to discuss separation date.
2. Health and Benefit Form goes to:   magalie.menard-charles@fdny.nyc.gov
    Section J is filled out by the employer and returned to the member. Member emails Form to DC-37 to;EEU@dc37.net for prescription, eye care, and dental benefits.
3. Separation Voucher is to be done by an employee one week before separation from service. The employee does not have to go to M.E.U anymore. Returnable equipment can be given to the station Supervisor but requires a signature by Supervisor as receiving equipment.
4. Annuity Form has directions on the form and is sent in after separation from the service.
5. Notify Local 2507 of retirement date and years of service.

Retirement Form

Health and Benefits Form

Annuity Form

Separation Voucher


UEPI 2507 Forms

MOS ASSAULTED FORM (PDF for download)

MOS ASSAULTED FORM (fill out online)

WITNESS TO ASSAULT

PARKING PLACARD (PDF for download)


9/11 WTC Forms

WTC Disability Application for Active Members

WTC Disability Application for Retired Members

Note: These official forms can only be used for their intended funciton. By downloading any of the forms on this page you agree with this statement.