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FORMS FOR CITY SERVICE

Updated 12.02.14  (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.


  1. Absence Analysis Calendars (AAC): 
     
  2. Accident to Employee Under Worker's Compensation Act, Report of (EB-49, r. 03/14):  Instructions (r. 03/14) / EB-49 Form
  3. Accrued Time Off Donor Program and Forms
  4. Application for Funeral Leave (CBP-155, R 10/05): MS Word / Adobe PDF
  5. Application for Injury Pay / Worker's Compensation Benefit (CBP-156A, R. 12/12):  MS Word / Adobe PDF
  6. Application for Sick Leave (CBP-156, R  3/14), Absence Due to Personal Illness:  MS Word  / Adobe PDF
  7. Automobile Allowance Form (Private) Information Sheet (CBP-138): MS Word  /  Adobe PDF
  8. Authorization for Travel Advance (CBP-210, R 10/05): MS Word
  9. Biweekly Commuting Miles, City of Milwaukee (CBP-194R, R. 01/00):  MS Word  /  Adobe PDF
  10. Budget Administration Forms (must have MINT access): click here
  11. Classification Related Forms and Guidelines: click here
  12. Complaint Form, Employee (for use by City employees only) (R. 10/09):  Adobe PDF
  13. Daily Report of "Time Off" Worked or Taken Off (CBP-171)  MS Word Adobe PDF
  14. Daily Automobile Allowance Record (CBP-139, R 2/00): MS Word / Adobe PDF
  15. Discipline and Grievance Procedure for General City Employees (R. 10.23.14): Adobe PDF
  16. Disciplinary Appeals to the City Service Commission, Guidelines for (R. 10.21.14)
           Appeal Form:
    • MS Word (This version is formatted as a fill-in form)
    • Adobe PDF (This version is formatted to be completed by hand)
  17. Disciplinary Reduction (Demotion) Notice (CS-113, R 2/12): MS Word / Adobe PDF
  18. Direct Deposit Form (C-457R4, 04/2006):  Adobe PDF
  19. Discharge Notice (CS-81, R 2/12): MS Word / Adobe PDF
  20. Donor Leave Program (Accrued Time Off Donor Program and Forms)
  21. Equal Rights Commission Complaint Form: not available at this time
  22. Expenses Incurred, Statement of (CBP-211, R 10/05): MS Word / Adobe PDF
  23. Favorable Occurance Commendation (CS-77, R 3/07): MS Word / Adobe PDF
  24. Flexible Choices Program Forms and Information
  25. FLSA Exemption Worksheet (all tests): MS Word / Adobe PDF
  26. FMLA Related Forms and Information (r. 4/30/14):  click here
  27. Funeral Leave, Application for (CBP-155, R 10/05): MS Word / Adobe PDF  -- click here for guidelines
  28. 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
  29. 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
  30. Grievance Procedure, Workplace Safety (General City) (R. 10/11):  click here
  31. Health Enrollment Form:  MS Word /  Adobe PDF  (click here for instructions)
  32. Hiring Checklist (R 08.23.13): Adobe PDF
  33. Injury Pay / Worker's Compensation Benefit, Application for (CBP-156A, R. 12/12):  MS Word / Adobe PDF
  34. I-9 Form and Instructions
  35. Job Description (CS-25, R. 12/09): click here
  36. Job Performance Improvement Plan, Employee: MS Word / Adobe PDF
  37. Jury Duty, Application for (C-139RS, R 4/05)
  38. Leave of Absence, Request for (CBP-129, R 11/10): MS Word / Adobe PDF
  39. Long-Term Disability Forms and Information
  40. Management Performance Planning and Review Forms: click here to access the forms listed below
    • Employee Job Performance Plan, Sample Competencies
  41. Military Training Leave, Riot or Civil Disturbance Duty, Pay Request for (CS-11, R. 4/13): MS Word / Adobe PDF
  42. New Employee Orientation Forms and Information (you will be redirected to the MINT)
  43. Payroll Deduction Authorization (CBP-112R, R 4/07): MS Word / Adobe PDF
  44. Personnel Requisition/Request to Fill (BMD-1): MS Excel
  45. Probationary Service, Report on (CS-58, R 7/13): MS Word / Adobe PDF
  46. Procurement Forms: click here to be redirected to the MINT
  47. Professional Development Award Application (R. 5.27.14):  MS Word  /  Adobe PDF
  48. Promotion without Competitive Examination (Rule IV, Sect. 9), Request for (CS-92, R 8/01): MS Word / Adobe PDF
  49. Provisional Appointee Statement of Understanding (r. 09/14) -- coming soon
  50. Reinstatement, Request for (R 12/13):   MS WordAdobe PDF
    • A Reinstatement Job Application must also be completed and attached to the Request for Reinstatement.  Click here to download the job application form, R 12/13) (Adobe PDF only).
  51. Removal from Eligible List (Appeal Form):  MS Word / Adobe PDF
  52. Request for Approval of AND Promotion After Underfill (Rule IV, Sect. 6) (CS-107, R 8/01): MS Word / Adobe PDF
  53. Request for Military Training Leave, Riot or Civil Disturbance Duty (CS-11, R 9/02; pg 2 R 11/03): MS Word / Adobe PDF
  54. Request for Optional Holiday (06.12.14):  MS Word  /  Adobe PDF
  55. Request for Selective Certification Authorization (CS-64, R 11/06):  MS Word / Adobe PDF
  56. Request for W-2 Form (C-403 r6, R 3/08): MS Word / Adobe PDF
  57. Residency Related Forms:
  58. Resignation Form (CBP-123, R 10/07): MS Word / Adobe PDF
  59. Safety Glass Prescription Order Form (R 02/10):  click here (you will be redirected to the MINT)
  60. Safety Orientation Checklist: Adobe PDF
  61. Selective Certification Authorization, Request for (CS-64, R 11/06):  MS Word / Adobe PDF
  62. Self-Service Instructions and Information: click here
  63. Sick Leave (Medical) Certification (CBP-157, R. 03/14/14):  Adobe PDF
  64. Sick Leave, Application for (CBP-156, R. 3/14/14), Absence Due to Personal Illness:  MS Word  /  Adobe PDF
  65. Statement of Economic Interest
  66. Statement of Expenses Incurred for City of Milwaukee (CBP-211, R. 10/05): MS Word
  67. Suspension Notice (CS-82, R 2/12): MS Word  Adobe PDF
  68. 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 (#69) and use the 2 forms that follow.
  69. Temporary Appointment Forms: click here for Memo to Departments (09.04.14)
  70. Termination Notice (CS-80, R 2/12): MS Word / Adobe PDF
  71. Training Enrollment Form (only to be used by departmental Training Information Coordinators for courses listed in the DER Training Bulletin)MS Word / Adobe PDF
  72. Travel Advance, Authorization for (CBP-210, R 10/05): MS Word
  73. Tuition Benefit/Reimbursement Application Process and Guidelines
  74. Underfill, Request for Approval of AND Promotion After Underfill (Rule IV, Sect. 6) (CS-107, R 8/01): MS Word / Adobe PDF
  75. Verbal Warning (CS-78, R 3/07): MS Word / Adobe PDF
  76. Waiver Form (Health/Dental): Adobe PDF
  77. Worksite Assessment Form (R 11/05): Adobe PDF
  78. Written Warning (CS-79, R 8/12): MS Word / Adobe PDF
  79. W-2 Form, Request for (C-403 r6, R 3/08): MS Word / Adobe PDF
  80. W-4 Form (2014):  Adobe PDF
  81. W-4 Form (2015):  Adobe PDF
  82. WT-4 Form (R 01/14) Employees Withholding Exemption Certificate /New Hire Reporting:  Adobe PDF

 

 

 

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 Calendars (AAC):


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


Application for Funeral Leave (CBP-155, R 10/05):  MS Word / Adobe PDF


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


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


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


Authorization for Travel Advance (CBP-210, R 10/05):  MS Word


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): click here


Classification Related Forms and Guidelines: click here


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


Discipline and Grievance Procedure for General City Employees (R. 10.23.14): 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


Donor Leave Program (Accrued Time Off Donor Program and Forms)


Equal Rights Commission Complaint Form: coming soon


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


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


FMLA Related Forms and Information (r. 4/30/14):  click here


Funeral Leave, Application for (CBP-155, R 10/05): MS Word / Adobe PDF  -- click here for guidelines


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): click here


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


Management Performance Planning and Review Forms: click here to access the forms listed below

  • 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: click here to 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):   MS WordAdobe PDF

A Reinstatement Job Application must also be completed and attached to the Request for Reinstatement. 

  • Click here to download the job application form, R 12/13) (Adobe PDF only).

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):  click here (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


Self-Service Instructions and Information: click here


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


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


Statement of Economic Interest


Statement of Expenses Incurred for City of Milwaukee (CBP-211, R. 10/05): MS Word


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


Temporary or Provisional Appointees Statement of Understanding (CS-114, R 3/07) The form CS-114 is no longer in use.  The Temporary Appointment and Provisional Appointment are now separate forms.  The "Provisional Appointee Statement of Understanding" will be posted shortly.


Temporary Appointment Forms: click here for 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 Advance, Authorization for (CBP-210, R 10/05): MS Word


Tuition Benefit/Reimbursement Application Process and 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



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

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Contact Us

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

Hours of Business
8:00 am - 4:45 pm
Monday - Friday

City Offices are closed on:

  • Wednesday, December 24
  • Thursday, December 25
  • Wednesday, December 31
  • Thursday, January 1, 2015

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

Employment Information
(414) 286-5555
StaffingInfo@milwaukee.gov
www.milwaukee.gov/jobs

City Services
(414) 286-CITY (2489)

TDD: (414) 286-2960