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FORMS FOR CITY SERVICE

Revised or added in 2017:

  • Revised 04.07.17:  Report on Probationary Service (CS-58)  - see #39
  • Revised 04.07.17:  Termination Notice (CS-80) - see #63
  • Added 2.24.17:  2017 Pay Progression Toolkit (see #36)
  • Revised 01.19.17: Safety Glass Prescription Order Form (see #53)

Questions?  Send email to jkamme@milwaukee.gov.


IMPORTANT!  Most of the Microsoft Word documents are formatted with fillable fields.  Open the document in Microsoft Word, move your cursor to the first box or "field." Type the information and press the "tab" key to move to the next box (the row will expand as you type).  For a check box, type an "x" or click the check box. (The MS Word versions are not meant to be completed by hand or on a typewriter.)  If you prefer to complete a form by hand or on a typewriter, print then complete the Adobe PDF version.


1.  Absence Analysis Calendar (AAC):


2.   Accident to Employee Under Worker's Compensation Act

WORKER'S COMPENSATION CLAIMS:  Effective Monday, October 3, 2016, Gallagher Basset Services, Inc. (GB) became the City’s third party administrator (TPA) for all worker compensation claims. GB has been in the risk management services industry since 1962 and has had a presence in the state of Wisconsin since 1981. GB offices are located in the City of Milwaukee at 115 S. 84th Street. The most critical change being implemented with this transition is the requirement to call 1-844-MIL-CLMS or 1-844-645-2567 to report a claim. This dedicated line will be staffed by Registered Nurses who will collect information regarding the injury, assess the situation, and make a recommendation of care.  For more information click here.


4.  Automobile Allowance Form (Private) Information Sheet (CBP-138):   MS Word  /  Adobe PDF


5.  Beneficiary Change Form (Active Employees), Pension and Life Insurance:
     http://www.cmers.com/Library/Forms.htm


6.  Biweekly Commuting Miles, City of Milwaukee (CBP-194R, R. 01/00):  MS Word  /  Adobe PDF


7.  Budget Administration Forms (you will be redirected to the MINT)


8.  Classification Related Forms and Guidelines


9.  Complaint Form, Employee (for use by City employees only) (R. 10/09):  Adobe PDF


10.  Daily Report of "Time Off" Worked or Taken Off (CBP-171)  MS Word Adobe PDF


11.  Daily Automobile Allowance Record (CBP-139, R 2/00): MS Word / Adobe PDF


12.  Dental Enrollment Form:  MS Word  /  Adobe PDF


13.  Disciplinary Appeals to the City Service Commission, Guidelines for (R. 10.21.14)

  • Appeal Form:  MS Word (formatted as a fill-in form)   /   Adobe PDF (to be completed by hand)

14.  Disciplinary Reduction (Demotion) Notice (CS-113, R 05.31.16): MS Word / Adobe PDF


15.  Direct Deposit Form (C-457R4, 04/2006)


16.  Discharge Notice (CS-81, R 08.02.16): MS Word / Adobe PDF


17.  Employee Assessment Form (01.06.16) - You will be redirected to the Pay Progression Toolkit


18.  Equal Rights Commission Complaint Form: coming soon


19.  Favorable Occurance Commendation (CS-77, R 3/07): MS Word / Adobe PDF


20.  Flexible Choices Program Forms and Information (2016)


21.  FLSA Exemption Worksheet (all tests): MS Word / Adobe PDF


22.  FMLA Toolkit: Forms, Policy and Information


23.  Funeral Leave, Application for (CBP-155, R 10/05)


24.  Grievance Forms:

  • Grievance Form, Fire Department (CC-233, R. 11/07): MS Word / Adobe PDF
  • Grievance Form, Fire Department, Bureau of Construction and Maintenance (CC-234, R. 11/07): MS Word / Adobe PDF

25.  Health Enrollment Form:  MS Word /  Adobe PDF  (click here for instructions)


26.  Hiring Checklist (R 08.23.13): Adobe PDF


27.  Injury Pay / Worker's Compensation Benefit, Application for (CBP-156A, R. 12/12)


28.  I-9 Form and Instructions


29.  Job Description (CS-25, R. 12/09):   http://city.milwaukee.gov/der/JobDescriptions


30. Jury Duty, Application for (C-139RS, R 4/05)


31.  Leave of Absence, Request for (CBP-129, R. 03.14.16): MS Word / Adobe PDF


32.  Long-Term Disability Forms and Information: 2016  /  2017


33.  Management Performance Planning and Review Forms (Employee Job Performance Plan, Sample Competencies)


34.  Military Training Leave, Riot or Civil Disturbance Duty, Pay Request for (CS-11, R. 4/13):


35.  New Employee Orientation (2017) Forms and Information (click here to be redirected to the MINT: https://mint.milwaukee.gov/NEO)


36.      2017 Pay Progression Toolkit
         ►  2016 Pay Progression Toolkit


37.  Payroll Deduction Authorization (CBP-112R, R 4/07): MS Word / Adobe PDF


38.  Performance Improvement Plan (PIP)


39.  Probationary Service, Report on (CS-58, R 04.07.17): MS Word / Adobe PDF


40.  Procurement Forms (you will be redirected to the MINT)


41.  Professional Development Award Application (R. 9.21.16):  MS Word  /  Adobe PDF


42.  Promotion without Competitive Examination (Rule IV, Sect. 9), Request for (CS-92, R 8/01):
       MS Word / Adobe PDF


43.  Provisional Appointee Statement of Understanding (r. 09/14) -- coming soon


44.  Reinstatement, Request for (R 12/13):  To request Reinstatement print and complete both of the following forms:

  1. Request for Reinstatement (includes MPS) (not for use by Fire or Police)
  2. Reinstatement Job Application
  • If you have been separated from City service for less than 1 year, submit the required documents to:  DER-Certification Section,  ATTN: Karen Kamlah, City Hall, Room 706, Milwaukee WI 53202-3515.
  • If you have been separated from City service for more than 1 year, submit the required documents to:  City Service Commission,  ATTN: Nola Nelson, City Hall, Room 706, Milwaukee WI 53202-3515.

45.  Removal from Eligible List (Appeal Form):  MS Word / Adobe PDF


46.  Request for Approval of AND Promotion After Underfill (Rule IV, Sect. 6) (CS-107, R 8/01): MS Word / Adobe PDF


47.  Request for Military Training Leave, Riot or Civil Disturbance Duty (CS-11, R 9/02; pg 2 R 11/03): MS Word / Adobe PDF


48.  Request for Optional Holiday (06.12.14):  MS Word  /  Adobe PDF


49.  Request for Selective Certification Authorization (CS-64, R 11/06):  MS Word / Adobe PDF


50.  Request for W-2 Form (C-403 r6, R 3/08): MS Word / Adobe PDF


51.  Residency Related Forms:


52.  Resignation Form (CBP-123, R. 08.02.16): MS Word / Adobe PDF


53.  Safety Glass Prescription Order Form (R. 01.19.17)

  • Please print the form only as needed; the form is subject to change at any time and the most recent version should always be used. The completed form must be signed by both the supervisor and DER Worker's Compensation Manager, Nilsa Rosado-Jurkiewicz.

54.  Safety Orientation Checklist: Adobe PDF


55.  Selective Certification Authorization, Request for (CS-64, R 11/06):  MS Word / Adobe PDF


56.  Separation Notice (non-disciplinary)  (04.20.16):  MS Word  /  Adobe PDF


57.  Sick Leave, Application for (CBP-156, R. 3/14/14), Absence Due to Personal Illness:  MS Word  /  Adobe PDF


58.  Sick Leave (Medical) Certification (CBP-157, R. 03/14/14):  Adobe PDF


59.  Statement of Economic Interest


60.  Suspension Notice (CS-82, R 08.02.16): MS Word  Adobe PDF


61.  Temporary or Provisional Appointees Statement of Understanding (CS-114, R 3/07)  The Temporary Appointment and Provisional Appointment are now separate forms.  The "Provisional Appointee Statement of Understanding" will be posted soon.  In the meantime, use the CS-114 FORM (click here) only for Provisional Appointments until the revised form is available.  For Temporary Appointments, please see the memo below) and use the 2 forms that follow.


62.  Temporary Appointment Forms (Memo to Departments; 09.04.14)


63.  Termination Notice (CS-80, R 04.07.17): MS Word / Adobe PDF


64.  Training Enrollment Form (only to be used by departmental Training Information Coordinators for courses listed in the DER Training Bulletin)MS Word / Adobe PDF


65.  Travel Expense Forms and Guidelines (you will be redirected to the MINT)

  • CPB-210:  Authorization for Travel Advance
  • CBP-211:  Statement of Expenses Incurred
  • CTE-001:  Conference and Training Evaluation
  • TRF-001:  Request for Travel on Behalf of City of Milwaukee
  • Travel Policy Overview
  • Travel Guidelines

66.  Tuition Benefit (Reimbursement) Application Instructions and Administrative Guidelines


67.  Underfill, Request for Approval of AND Promotion After Underfill (Rule IV, Sect. 6) (CS-107, R 8/01): MS Word / Adobe PDF


68.  Verbal Warning (CS-78, R 3/07): MS Word / Adobe PDF


69.  Waiver Form (Health/Dental): Adobe PDF


70.  Worksite Assessment Form (R 11/05): Adobe PDF


71.  Written Warning (CS-79, R 10.14.15): MS Word / Adobe PDF


72.  W-2 Form, Request for (C-403r7, R 10.14.16): MS Word / Adobe PDF


73.  W-4 Form (2017):  Adobe PDF


74.  WT-4 Form (R 01/14) Employees Withholding Exemption Certificate /New Hire Reporting:  Adobe PDF

city of milwaukee department of employee relations with a picture of city hall

 

 

Contact Us

City Hall, Room 706
200 E. Wells Street
Milwaukee, WI 53202-3515

General Information
(414) 286-3751
(414) 286-5555 (job hotline)
(414) 286-2960 (TDD)
Email