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FORMS FOR CITY SERVICE

Updated 07.21.15  (Always use the most recent version of the forms.)

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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.


Absence Analysis Calendar (AAC):


Accident to Employee Under Worker's Compensation Act, Report of (EB-49, r. 03/14):  Instructions (r. 03/14) / EB-49 Form

ATTENTION DPW MANAGEMENT:  All DPW Injuries/EB 49's must be submitted through the DPW Incident Reports Application.  Go to:  http://dpwapps.mpw.net/IncidentReports.php

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


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


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


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


Classification Related Forms and Guidelines


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


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


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


Dental Enrollment Form:  MS Word  /  Adobe PDF


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


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)

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


Direct Deposit Form (C-457R4, 04/2006):  Adobe PDF


Discharge Notice (CS-81, R 2/12): MS Word / Adobe PDF


Equal Rights Commission Complaint Form: coming soon


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


Flexible Choices Program Forms and Information (2015)


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


FMLA Toolkit: Forms, Policy and Information


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


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

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

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


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


Hiring Checklist (R 08.23.13): Adobe PDF


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


I-9 Form and Instructions


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


Job Performance Improvement Plan, Employee: MS Word / Adobe PDF


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


Leave of Absence, Request for (CBP-129, R 11/10): MS Word / Adobe PDF


Long-Term Disability Forms and Information (2015)


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


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


New Employee Orientation Forms and Information (you will be redirected to the MINT)


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 7/13): MS Word / Adobe PDF


Procurement Forms (you will be redirected to the MINT)


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


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


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


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, send 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, send the required documents to:  City Service Commission,  ATTN: Nola Nelson, 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


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


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


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


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


Residency Related Forms:


Resignation Form (CBP-123, R 10/07): MS Word / Adobe PDF


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


Safety Orientation Checklist: Adobe PDF


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


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


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


Statement of Economic Interest


Suspension Notice (CS-82, R 2/12): MS Word  Adobe PDF


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.


Temporary Appointment Forms (Memo to Departments; 09.04.14)


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


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


Travel Expenses:  The following documents are on the MINT. Login to the MINT (https://mint.milwauke.gov), then go to Employee Resources ⇒ Travel Expenses

  • 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

Tuition Benefit (Reimbursement) Application Instructions and Administrative Guidelines


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 8/12): MS Word / Adobe PDF


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


W-4 Form (2015):  Adobe PDF


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

  8:00 a.m. - 4:45 p.m.

Monday - Friday
City offices will be closed 9/7/15.

General Information
(414) 286-3751
TDD: (414) 286-2960
emprel@milwaukee.gov
www.milwaukee.gov/der

Employment Opportunities
(414) 286-5555 (24-hour recording)
StaffingInfo@milwaukee.gov
www.milwaukee.gov/jobs

Verification of Employment
(City of Milwaukee employees)
(800) 996-7566
Employer Code: 11692
https://www.theworknumber.com/

CITY SERVICE REQUESTS
(414) 286-CITY (2489)
http://city.milwaukee.gov/ucc