Forms for City Employees

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Many of the MS WORD forms are formatted so that you type the information directly on the form, then print it. If you prefer to complete a form "by hand" please use the Adobe PDF version. Move your cursor to the first box or "field." Type the information and press the "tab" key to move to the next box. Place an "x" in check boxes.

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Absence Analysis Calendar, 2009 (R. 9-16-08): MS Word / Adobe PDF
Absence Analysis Calendar, 2008: MS Word / Adobe PDF
Absence Analysis Calendar, 2007: MS Word / Adobe PDF
Accident to Employee Under Worker's Compensation Act, Report of (EB-49, R 10/06): MS Word (Click here for instructions regarding the EB-49 form; R 10/05)
Appeal Forms:
- Disciplinary: Adobe PDF
- Removal from Eligible List: MS Word / Adobe PDF
Budget Administration Forms (must have MINT access): click here
Classification Related Forms and Guidelines: click here
Daily Automobile Allowance Record (CBP-139, R 2/00): MS Word / Adobe PDF (Click here for the Rate Chart)
Daily Report "Time Off" Overtime Worked or Taken Off (CBP-171): MS Word / Adobe PDF
Dental Enrollment Form (2008): MS Word / Adobe PDF
- Dental Insurance Information (2008): click here
Direct Deposit Form (C-457R4) (04/2006): This form is not available online. Please contact your payroll personnel for a form, or contact the Comptroller's Office.
Disciplinary Reduction (Demotion) Notice (CS-113, R 3/07): MS Word / Adobe PDF
Discharge Notice (CS-81, R 3/07): MS Word / Adobe PDF
Employee Complaint Form ( for use by City employees) (R 12/04) : Adobe PDF
Engineering Merit Increment Application (R 4/07): MS Word / Adobe PDF
Equal Rights Commission Complaint Form: Adobe PDF
Expenses Incurred, Statement of (CBP-211, R 10/05): MS Word / Adobe PDF
Favorable Occurance Commendation (CS-77, R 3/07): MS Word / Adobe PDF
Flexible Choices Program Forms and Information: click here
FLSA Exemption Worksheet (all tests): MS Word / Adobe PDF
FMLA Related Forms:
- Medical Certification Under the FMLA (R 9/03): MS Word / Adobe PDF
- Request for Leave Under the FMLA (R 6/07): MS Word / Adobe PDF
- Coming soon: Request for Additional Period of Health and Dental Insurance Under the FMLA
Funeral Leave, Application for (CBP-155, R 10/05): MS Word / Adobe PDF
Grievance Forms:
- Grievance Initiation (CS-50, R 11/06): MS Word / Adobe PDF
- Grievance Disposition (CS-51, R 7/07): MS Word / Adobe PDF
- Grievance Appeal (CS-52, R 7/07): MS Word / Adobe PDF
- 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
Grievance Procedure for Management and Non-Represented City Employees: Adobe PDF
Health Enrollment Form (2008): Adobe PDF
- Click here for 2008 Health Insurance Information.
Hiring Checklist (R 5/07): Adobe PDF
- Safety Orientation Checklist: Adobe PDF
Job Description (CS-25, R 1/07): click here
Job Performance Improvement Plan, Employee: MS Word / Adobe PDF
Jury Duty, Application for (C-139RS, R 4/05): MS Word / Adobe PDF
Leave of Absence, Request for (CBP-129, R 3/07): MS Word / Adobe PDF
Long-Term Disability Forms and Information: click here
Management Performance Planning and Review Forms: click here
Military Training Leave, Riot or Civil Disturbance Duty, Request for (CS-11, R 9/02; pg 2 R 11/03): MS Word / Adobe PDF
New Employee Orientation: click here for more information (you must have Intranet access)
- 2009 Employee Information Sheet (pdf)
- 2009 Supervisor Information Sheet (pdf)
- 2009 New Employee Orientation Schedule (pdf)
Office Support Continuing Education Incentive Program Application (ER-300, R 5/06): MS Word / Adobe PDF
Payroll Certification (CS-90) - MUST be printed on yellow paper: PDF format
Payroll Deduction Authorization (CBP-112R, R 4/07): MS Word / Adobe PDF
Personnel Requisition/Request to Fill (BMD-1): MS Excel
Probationary Service, Report on (CS-58, R 4/08): MS Word / Adobe PDF
Procurement Forms (must have MINT access) : click here
Promotion without Competitive Examination (Rule IV, Sect. 9), Request for (CS-92, R 8/01): MS Word / Adobe PDF
Reinstatement, Request for (R 10/06): MS Word / Adobe PDF
Residency Related Forms and Information:
- City Residency Requirement: Adobe PDF
- Finding of Necessity: Adobe PDF
- Residency Compliance Certification Form: Adobe PDF
Resignation Form (CBP-123, R 10/07): MS Word / Adobe PDF
Savings Bonds, U.S. (SB-2362E) Submit the completed form: Liz Pizano, Office of the Comptroller, City Hall, Room 404: Adobe PDF
Safety Glass Prescription Order Form (R 11/07): Adobe PDF
Safety Orientation Checklist: Adobe PDF
Selective Certification Authorization, Request for (CS-64, R 11/06): MS Word / Adobe PDF
Self-Service Instructions & Information: click here
Sick Leave Certification ( CBP-157): Adobe PDF
Sick Leave or Injury Pay, Application for (CBP-156, R 1/95): MS Word / Adobe PDF
Suspension Notice (CS-82, R 3/07): MS Word / Adobe PDF
Temporary or Provisional Appointees Statement of Understanding (CS-114, R 3/07): MS Word / Adobe PDF
Termination Notice (CS-80, R 3/07): MS Word / Adobe PDF
Travel Advance, Authorization for (CBP-210, R 10/05): MS Word
Tuition Benefit/Reimbursement Applications (ER-75): click here
Underfill, Request for Approval of AND Promotion After Underfill (Rule IV, Sect. 6) (CS-107, R 8/01): MS Word / Adobe PDF
Verbal Warning (CS-78, R 3/07): MS Word / Adobe PDF
Waiver Form (Health/Dental): Adobe PDF
Worksite Assessment Form (R 11/05): Adobe PDF
Written Warning (CS-79, R 3/07): MS Word / Adobe PDF
W-2 Form, Request for (C-403 r6, R 3/08): MS Word / Adobe PDF
W-4 Form (2008): Adobe PDF
W-4 Form (2009): Adobe PDF
WT-4 Form (R 11/04) Employees Withholding Exemption Certificate /New Hire Reporting: Adobe PDF

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