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FORMS FOR CITY SERVICE

Recently Revised or Added:

Revised 11.17:17 Payroll Deduction Authorization (CPB-112R) see#38
Revised 09.20.17 FMLA Designation Notice see#22
Revised 08.17.17 FMLA Request for Family & Medical Leave see#21
Added   06.27.17 Hiring Packet see#26
Revised 06.19.17 Hiring Checklist see#26
Revised 04.07.17 Report on Probationary Service (CS-58) see#40
Revised 04.07.17 Termination Notice (CS-80) see#64
Added   02.24.17 2018 Pay Progression Toolkit see#37
Revised 01.19.17 Safety Glass Prescription Order Form see#54
     

Questions? Send email to tlhanki@milwaukee.gov

IMPORTANT!
Most of the Microsoft Word documents are formatted with fillable fields and should be completed using Microsoft Word. If you complete a form by hand, print the Adobe PDF version of the document and not the Microsoft Word version.

  1. Absence Analysis Calendar (AAC):

  2. Accident to Employee Under Worker's Compensation Act

    • 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.

  3. Accrued Time-Off Donor Program:  Forms, Guidelines and Instructions

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

  5. Beneficiary Change Form (for active employees), Pension and Life Insurance: http://www.cmers.com/Library/Forms.htm

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

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

  8. Classification Related Forms and Guidelines

  9. Complaint Form, Employee (for use by General City employees only) (R. 1.31.18):MS Word

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

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

  12. Dental Enrollment Form:  MS Word  /  Adobe PDF

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

  14. Disciplinary Appeals to the City Service Commission

  15. Disciplinary Reduction (Demotion) Notice (CS-113, R 05.31.16): MS Word / Adobe PDF

  16. Discharge Notice (CS-81, R 08.02.16): MS Word / Adobe PDF

    • If the employee is separating from City service for reasons other than retirement, please provide them with an informational brochure regarding benefits before separation occurs.

  17. Employee Assessment Form (Annual):

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

  19. Flexible Spending Account (FSA) Forms and Information

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

  21. FMLA Toolkit: Forms, Policy and Information  

  22. FMLA Designation Notice 9.20.17 Adobe PDF  

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

  24. Grievance Forms:

  25. Health Enrollment Form (Instructions):  MS Word /  Adobe PDF 

  26. Hiring Checklist (R 06.19.17): Adobe PDF 

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

  28. I-9 Form and Instructions

  29. Job Description (CS-25, R. 12/09)

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

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

  32. Long-Term Disability Forms and Information (2017 benefit)

  33. Management Performance Planning and Review Form (Employee Job Performance Plan, Sample Competencies)

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

  35. New Employee Orientation (2017) Forms and Information (you will be redirected to the MINT)

  36. Pay Progression:  2017 Toolkit 

  37. Pay Progression: 2018 Toolkit

  38. Payroll Deduction Authorization (CBP-112R, R 11/17): MS Word / Adobe PDF

  39. Performance Improvement Plan (PIP)

  40. Probationary Service, Report on (CS-58, R 04.07.17): MS Word / Adobe PDF

  41. Professional Development Award Application (R. 9.21.16):  MS Word

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

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

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

  45. 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.
  46. Removal from Eligible List (appeal form):  MS Word / Adobe PDF
     
  47. Request for Approval of AND Promotion After Underfill (Rule IV, Sect. 6) (CS-107, R 8/01): MS Word / Adobe PDF
     

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

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

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

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

  52. Residency Related Forms:

  53. Resignation Form (CBP-123, R. 08.02.16): MS Word / Adobe PDF

    • If the employee is separating from City service for reasons other than retirement, please provide them with an informational brochure regarding benefits before separation occurs.

  54. 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)

  55. Safety Orientation Checklist: Adobe PDF

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

  57. Separation Notice (non-disciplinary)  (04.20.16):  MS Word  /  Adobe PDF

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

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

  60. Statement of Economic Interest

  61. Suspension Notice (CS-82, R 08.02.16): MS Word  /  Adobe PDF

  62.  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.

  63. Temporary Appointment Forms (memo to departments 09.04.14)

  64. Termination During Probation Notice (CS-80, R 04.07.17): MS Word / Adobe PDF

    • If the employee is separating from City service for reasons other than retirement, please provide them with an informational brochure regarding benefits before separation occurs.

  65. Training Enrollment Form (to be used by Training Information Coordinator for courses listed in the DER Training Bulletin):  MS Word

  66. 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

  67. Tuition Benefit Application Instructions and Administrative Guidelines

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

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

  70. Waiver Form (for Health and Dental): Adobe PDF

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

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

  73. W-2 Form, Request for (C-403r7, R 10.14.16): MS Word / Adobe PDF

  74. W-4 Form (2018):  Adobe PDF   (submit to your payroll personnel after completion)

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

city of milwaukee department of employee relations with a picture of city hall

 


Contact Us

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

General Information
(414) 286-3751
(414) 286-5555 (job hotline)
(414) 286-2960 (TDD)
Email