Forms & Documents

HSA Deduction

Dental Insurance Enrollment

Vision Insurance Enrollment

Health Insurance Enrollment

Vision Benefit Grid

Pharmacy Benefit Grid

CarePlus Dental

HSA Employee Guide

UMR Medical Family

UMR Medical Individual

Killed in the Line of Duty

ET Beneficiary Election

Applicant Forms

• Reference List - Captain
• Reference List - Lieutenant
• Chemical Screening Consent Form (Police Officer Applicants Only)
• Veteran Points

Newhire Forms

The following forms/copies are required for employment with the City of Kenosha. Please complete and return to:

City of Kenosha

Human Resources Department

625 52nd Street

Room 205

Kenosha, WI 53140

• I-9 Form
• FICA Alternative Form (Part-Time and Seasonal Employees)
• Form SSA 1945 (Firefighters Only)
• Payroll Direct Deposit Form
• Personnel Policies and Regulations
• Work Rules
• Safety Rules
• Harassment Policy
• Drug & Alcohol Policy
• Drug & Alcohol Policy (Transit)
• Drug-Free Workplace Policy (Transit)
• Internet Media Policy
• Internet Usage Policy

If you have questions, please contact us at 262.653.4130 or email