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Transfer Request
for State of Wisconsin Civil Service Employees only

Your application will be maintained in our transfer file for six (6) months from the date of submission. You may phone to renew your request for a subsequent six-month period. Please read the information "Information for the State Employee Considering Transfer", before completing this form.

Employee Information
* required fields
Today's Date:*

Social Security #:

Last Name:*

First Name:*

E-mail Address:*

List Current Civil Service Title:*

Current State Agency where Employed:*

Home Address:*

City:*

State:*

Zip Code:*

Home Phone:*

Work Phone:


What classification(s) are you interested in transfering to:*
   

Ethnic Group (select one)
Black American Indian/Alaskan Asian or Pacific Islander Hispanic White

Gender (select one)
Male
Female

Person with disabilities? (select one)
Yes
No

Will you Accept Part-Time Work? (select one)*
Yes
No

Are you Willing to Demote? (select one)*
Yes
No

I certify that the above information is correct. I also understand that the information provided above will be available to State Personnel Managers and Employing Officials and authorize its release. I request that UW-Parkside be granted access to State Personnel records as relates to dates of employment, performance evaluations, attendance records, and any other records that may provide information relating to my state employment performance and/or ability to perform duties as described in civil service classification specifications and/or position descriptions.

I certify that the above information is correct.*
This information is correct.

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