- Absence Analysis Calendar (AAC):
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Accident to Employee Under Worker's Compensation Act
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WORKER'S COMPENSATION CLAIMS: Effective 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.
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Accrued Time-Off Donor Program: Forms, Guidelines and Instructions
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Automobile Allowance Form (Private) Information Sheet (CBP-138): MS Word / Adobe PDF
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Beneficiary Change Form (for active employees), Pension and Life Insurance: http://www.cmers.com/Library/Forms.htm
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Biweekly Commuting Miles, City of Milwaukee (CBP-194R, R. 01/00): MS Word / Adobe PDF
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Budget Administration Forms (you will be redirected to the MINT)
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Classification Related Forms and Guidelines
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Complaint Form, Employee (for use by General City employees only) (R. 1.31.18):MS Word
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Daily Report of "Time Off" Worked or Taken Off (CBP-171) MS Word / Adobe PDF
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Daily Automobile Allowance Record (CBP-139, R 2/00): MS Word / Adobe PDF
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Dental Enrollment Form: MS Word / Adobe PDF
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Direct Deposit Form (C-457R4, 04/2006)
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Disciplinary Appeals to the City Service Commission
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Disciplinary Reduction (Demotion) Notice (CS-113, R 05.31.16): MS Word / Adobe PDF
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Discharge Notice (CS-81, R 08.02.16): MS Word / Adobe PDF
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Employee Assessment Form (Annual):
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Favorable Occurence Commendation (CS-77, R 3/07): MS Word / Adobe PDF
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Flexible Spending Account (FSA) Forms and Information
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FLSA Exemption Worksheet (all tests): MS Word / Adobe PDF
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FMLA Toolkit: Forms, Policy and Information
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FMLA Designation Notice 9.20.17 Adobe PDF
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Funeral Leave, Application for (CBP-155, R 10/05)
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Grievance Forms:
- Discipline and Grievance Procedure for General City Employees (R. 05.05.16): Adobe PDF
- Grievance Procedure, Workplace Safety (General City) (R. 10/11): 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
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Health Enrollment Form (Instructions): MS Word / Adobe PDF
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Hiring Checklist (R 06.19.17): Adobe PDF
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Injury Pay / Worker's Compensation Benefit, Application for (CBP-156A, R. 12/12)
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I-9 Form and Instructions
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Job Description (CS-25, R. 12/09)
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Jury Duty, Application for (C-139RS, R 4/05)
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Leave of Absence, Request for (CBP-129, R. 03.14.16): MS Word / Adobe PDF
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Long-Term Disability Forms and Information (2017 benefit)
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Management Performance Planning and Review Form (Employee Job Performance Plan, Sample Competencies)
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Military Training Leave, Riot or Civil Disturbance Duty, Pay Request for (CS-11, R. 4/13): MS Word / Adobe PDF
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New Employee Orientation (2017) Forms and Information (you will be redirected to the MINT)
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Pay Progression: 2017 Toolkit
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Pay Progression: 2018 Toolkit
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Payroll Deduction Authorization (CBP-112R, R 11/17): MS Word / Adobe PDF
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Performance Improvement Plan (PIP)
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Probationary Service, Report on (CS-58, R 04.07.17): MS Word / Adobe PDF
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Professional Development Award Application (R. 9.21.16): MS Word
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Promotion without Competitive Examination (Rule IV, Sect. 9), Request for (CS-92, R 8/01): MS Word / Adobe PDF
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Provisional Appointee Statement of Understanding (r. 09/14) -- coming soon
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Purchasing Forms (you will be redirected to the MINT)
- Reinstatement, Request for (R 12/13): To request Reinstatement print and complete both of the following forms:
- Request for Reinstatement (not for use by Fire or Police)
- Reinstatement Job Application
- If you have been separated from City service for less than 1 year, submit the required documents to: DER-Certification Section, 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: Monica Dickerson, City Hall, Room 706, Milwaukee WI 53202-3515.
- Removal from Eligible List (appeal form): MS Word / Adobe PDF
- Request for Approval of AND Promotion After Underfill (Rule IV, Sect. 6) (CS-107, R 8/01): MS Word / Adobe PDF
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Request for Military Training Leave, Riot or Civil Disturbance Duty (CS-11, R 9/02; pg 2 R 11/03): MS Word / Adobe PDF
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Request for Optional Holiday (06.12.14): MS Word / Adobe PDF
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Request for Selective Certification Authorization (CS-64, R 11/06): MS Word / Adobe PDF
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Request for W-2 Form (C-403 r6, R 3/08): MS Word / Adobe PDF
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Residency Related Forms:
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Resignation Form (CBP-123, R. 08.02.16): MS Word / Adobe PDF
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Safety Glass Prescription Order Form (R. 01.19.17)
- Please print the form only as needed as the form is subject to change at any time and only the most recent version should be used. The completed form must be signed by both the Supervisor and Nilsa Rosado-Jurkiewiecz, Worker's Compensation Manager - Dept. of Employee Relations.
- Prescription Safety Glass Policy (r. 02.06.15)
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Safety Orientation Checklist: Adobe PDF
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Selective Certification Authorization, Request for (CS-64, R 11/06): MS Word / Adobe PDF
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Separation Notice (non-disciplinary) (04.20.16): MS Word / Adobe PDF
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Sick Leave, Application for (CBP-156, R. 3/14/14), Absence Due to Personal Illness: MS Word / Adobe PDF
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Sick Leave (Medical) Certification (CBP-157, R. 03/14/14): Adobe PDF
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Statement of Economic Interest
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Suspension Notice (CS-82, R 08.02.16): MS Word / Adobe PDF
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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.
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Temporary Appointment Forms (memo to departments 09.04.14)
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Termination During Probation Notice (CS-80, R 04.07.17): MS Word / Adobe PDF
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Training Enrollment Form (to be used by Training Information Coordinator for courses listed in the DER Training Bulletin): MS Word
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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
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Tuition Benefit Application Instructions and Administrative Guidelines
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Underfill, Request for Approval of AND Promotion After Underfill (Rule IV, Sect. 6) (CS-107, R 8/01): MS Word / Adobe PDF
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Verbal Warning (CS-78, R 3/07): MS Word / Adobe PDF
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Waiver Form (for Health and Dental): Adobe PDF
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Worksite Assessment Form (R 11/05): Adobe PDF
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Written Warning (CS-79, R 10.14.15): MS Word / Adobe PDF
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W-2 Form, Request for (C-403r7, R 10.14.16): MS Word / Adobe PDF
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W-4 Form (2018): Adobe PDF (submit to your payroll personnel after completion)
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WT-4 Form (R 01/14) Employees Withholding Exemption Certificate/New Hire Reporting: Adobe PDF