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FORMS FOR CITY SERVICE

Recently REVISED or ADDED Forms:


      ► Added 04.20.16:  Separation Notice (non-disciplinary)
      ► Revised 03.14.16:  Resignation Form (CBP-123)
      ► Added 01.07.16:  Employee Assessment Form (pay progression)

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, Report of (EB-49, r. 03/14):
     Instructions (r. 03/14) / EB-49 Form


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


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


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


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


9.  Classification Related Forms and Guidelines


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


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


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


13.  Dental Enrollment Form:  MS Word  /  Adobe PDF


14.  Discipline and Grievance Procedure for General City Employees (R. 02.23.15): Adobe PDF


15.  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)

16.  Disciplinary Reduction (Demotion) Notice (CS-113, R 2/12): MS Word / Adobe PDF


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


18.  Discharge Notice (CS-81, R 11.12.15): MS Word / Adobe PDF


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


20.  Equal Rights Commission Complaint Form: coming soon


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


22.  Flexible Choices Program Forms and Information (2016)


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


24.  FMLA Toolkit: Forms, Policy and Information


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


26.  Furlough, Mandatory:

  • Payroll Reporting Form for Hours in Mandatory Furlough Week (FRL-1; 3/26/12):  MS Word / Adobe PDF
  • Policy and Administrative Guidelines:  Adobe PDF

27.  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

28.  Grievance Procedure, Workplace Safety (General City) (R. 10/11):  click here


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


30.  Hiring Checklist (R 08.23.13): Adobe PDF


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


32.  I-9 Form and Instructions


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


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


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


36.  Long-Term Disability Forms and Information (2015)  /  Long-Term Disability Forms and Information (2016)


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


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


39.  New Employee Orientation Forms and Information (r. 12.14.15) (you will be redirected to the MINT)


40.  Pay Progression Toolkit


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


42.  Performance Improvement Plan (PIP)


43.  Probationary Service, Report on (CS-58, R 7/13): MS Word / Adobe PDF


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


45.  Professional Development Award Application (R. 5.27.14):  MS Word  /  Adobe PDF


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


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


48.  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.

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


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


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


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


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


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


55.  Residency Related Forms:


56.  Resignation Form (CBP-123, R. 03.14.16): MS Word / Adobe PDF


57.  Safety Glass Prescription Order Form (R 02/10) -- (you will be redirected to the MINT)


58.  Safety Orientation Checklist: Adobe PDF


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


60.  Separation Notice (non-disciplinary)MS Word  /  Adobe PDF


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


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


63.  Statement of Economic Interest


64.  Suspension Notice (CS-82, R 11.12.15): MS Word  Adobe PDF


65.  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.


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


67.  Termination Notice (CS-80, R 2/12): MS Word / Adobe PDF


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


69.  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

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


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


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


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


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


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


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


77.  W-4 Form (2016):  Adobe PDF


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

Contact Us

City Hall
200 E. Wells Street
Room 706
Milwaukee, WI 53202-3515
Monday - Friday; 8:00 a.m. - 4:30 p.m.

 

General Information
(414) 286-3751
TDD: (414) 286-2960
Email

Employment Opportunities
(414) 286-5555 (24-hour recording)
Email

Verification of Employment
(City of Milwaukee employees)
(800) 996-7566
Employer Code: 11692

Click for Action
(414) 286-CITY (2489)
Email