DER homepage

Forms for City Service

Recently Revised or Added:

Revised 05.09.18 Residence Statement see#52
Revised 01.03.20 Payroll Deduction Authorization (CPB-112R) see#35
Added    08.30.19 Hiring Packet see#26
Revised 08.30.19 Hiring Checklist see#26
Revised 04.07.17 Report on Probationary Service (CS-58) see#40
Revised 06.05.19 Termination Notice (CS-80) see#64
Added    02.24.17 2018 Pay Progression Toolkit see#37
Revised 07.01.21 Safety Glass Prescription Order Form see#54

Questions? Send email to


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):

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

  2. Automobile Allowance Form (Private) Information Sheet (CBP-138): MS Word

  3. Beneficiary Change Form (for active employees), Pension and Life Insurance:

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

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

  6. Classification Related Forms and Guidelines

  7. Complaint Form, Employee (for use by General City employees only) (R. 03.03.21):MS Word

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

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

  10. Dental Enrollment Form: MS Word Adobe PDF

  11. Direct Deposit Form

  12. Disciplinary Appeals to the City Service Commission

  13. Disciplinary Reduction (Demotion) Notice (CS-113, R 06.05.19): MS Word / Adobe PDF

  14. Discharge Notice (CS-81, R 01.07.20): 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.

  15. Employee Accident-Worker's Compensation Claim:  For more information click here.

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

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

  18. FMLA Toolkit: Forms, Policy and Information  

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

  20. Grievance Forms:

  21. Health Enrollment Form (Instructions)MS Word /  Adobe PDF 
  22. Hiring Packet (you will be redirected to the MINT) 

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

  24. Internal Job Announcement Template: MS Word / Adobe PDF

  25. I-9 Form and Instructions

  26. Job Description (CS-25, R. 11/14)

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

  28. Leave of Absence, (Request for R. 01.17.20): MS Word / Adobe PDF

  29. Leave of Absense,( Exempt Employees Request for): R. 01.17.20 MS.Word / Adobe PDF

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

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

  32. New Employee Orientation (2021) Forms and Information (you will be redirected to the MINT)

  33. Pay Progression: 2018 Toolkit

  34. Payroll Deduction Authorization (CBP-112R, R 01.03.20): MS Word / Adobe PDF

  35. Performance Improvement Plan (PIP)

  36. Political Activity Policy

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

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

  39. Promotional Guidance and Materials-Internal (you will be redirected to the MINT)

  40. Promotion without Competitive Examination (Rule IV, Sect. 9), Request for (CS-92, R 6/20): MS Word / Adobe PDF

  41. Provisional Apointment (r.12/20)-Adobe PDF

  42. Provisional Appointee Statement of Understanding (r. 12/20) - Adobe PDF

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

  44. 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 (3.1.21)
      • 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: Karen Biernat, City Hall, Room 706, Milwaukee WI 53202-3515.
  45. Removal from Eligible List (appeal form):  MS Word / Adobe PDF
  46. Request for Approval of AND Promotion After Underfill (Rule IV, Sect. 6) (CS-107, R 7/20): MS Word / Adobe PDF
  47. Request for Military Training Leave, Riot or Civil Disturbance Duty (CS-11, R 9/02; pg 2 R 11/03): MS Word / Adobe PDF

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

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

  50. Request for W-2 Form (C-403 r6, R 11/19): Adobe PDF

  51. Residency Related Forms:

  52. Resignation Form (CBP-123, R. 10.04.21): MS Word / Adobe PD

  53. Safety Glass Prescription Order Form (R. 07.01.21) 

    • 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)
  54. Safety Orientation Checklist: Adobe PDF

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

  56. Separation Notice (non-disciplinary)  (06.05.19):  MS Word  /  Adobe PDF

  57. Sick Leave, Application for (CBP-156, R. 10.20.20), Absence Due to Illness:  MS Word Adobe PDF

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

  59. Statement of Economic Interest

  60. Suspension Notice (CS-82, R 06.04.19): MS Word / Adobe PDF

  61. Temporary Appointment Forms (memo to departments 09.04.14)

  62. Termination During Probation Notice (CS-80, R 06.05.19): MS Word / Adobe PD

  63. Training Enrollment Form :  MS Word

  64. 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
  65. Tuition Benefit Application Instructions and Administrative Guidelines

  66. Verbal Warning (CS-78, R 03/07): MS Word / Adobe PDF

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

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

  69. Written Warning (CS-79, R 7.11/19): MS Word / Adobe PDF

  70. W-2 Form, Request for (C-403r7, R 02/21):  Adobe PDF

  71. W-4 Form (2021): Adobe PDF   (submit to your payroll personnel after completion)

  72. WT-4 Form (R 01/1) Employees Withholding Exemption Certificate/New Hire Reporting:  Adobe PDF

This site is powered by the Northwoods Titan Content Management System