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:


Approved:

Recommended:


_____________________________________________
Appointing Authority 


_________________________________________
Chief


______________________________________________
Chairperson Municipal Fire and Police Civil Service Board