PERSONNEL ACTION FORM
To the Municipal Fire and Police Civil Service Board

Explanation | Common Errors to Avoid
   
(city or fire protection district)  
Today's Date
 
1.
Employee's Last Name First Name M.I. Suffix
Date of Birth
Social Security No.
 
2.
Department
3.
Personnel Action
4.
Effective Date of Action
 
5.
From:
6.
To:
7.
Monthly Salary
 
8.
Remarks:


Recommended:

   




Approved:

_____________________________________

Chief

   


_____________________________________________
Appointing Authority
 

 

 

   


______________________________________________
Chairperson Municipal Fire and Police Civil Service Board