Sample - Continuous Absence - Exhaustion Of Paid Leave - No Communication (Page 3 of 4) in pdf

you wish to schedule an appointment. Further, if you have reason to believe the information contained

in this letter is inaccurate, then you may respond in writing, provided your response is postmarked

within fifteen (15) calendar days of the date of this letter.

Since failure to comply with the provisions of this letter will result in a dismissal, if such personnel action

occurs, you have a right to grieve the dismissal through the West Virginia Public Employees Grievance

Procedure, contained in W. V

. C

§6C‐2‐1 et seq. If you choose to exercise your grievance rights, you

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must submit your grievance, on the prescribed form, within fifteen (15) working days of the effective

date of this action, to [name and address of Chief Administrator] at Level One of the Procedure. As

provided in the statute, you may proceed to Level Three of the Procedure by filing your grievance

directly with the Public Employees Grievance Board upon the agreement of the chief administrator, or

when dismissed, suspended without pay, or demoted or reclassified resulting in a loss of compensation

or benefits. You must provide copies of your grievance accordingly to the Public Employees Grievance

Board at 1596 Kanawha Boulevard, East, Charleston, West Virginia, 25311; [agency copy ‐ name and

address]; and the Director of the Division of Personnel, Building 6, Room B‐416, State Capitol Complex,

Charleston, West Virginia, 25305. Details regarding the grievance procedure, as well as grievance forms,

are available at the Board’s web site at (304) 558‐

3361 or toll‐free at (866) 747‐6743.

Should dismissal occur, you may continue your Public Employees Insurance Agency (PEIA) insurance

benefits for three (3) months after the end of the month in which you are removed from the payroll, at

no added cost to you. See W. V

. C

§5‐16‐13(c). Additionally, under the Consolidated Omnibus

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Budget Reconciliation Act of 1985 (COBRA), you may be eligible for up to eighteen (18) months of

continued health coverage; therefore, you may wish to contact your payroll office or PEIA, at (304) 558‐

7850, or 1‐888‐680‐7342, for specific eligibility, coverage and premium information.

Sincerely,

[Appropriate Signature Authority]

Enclosures:

Section 14, DOP Administrative Rule

DOP Leave Request Forms [OR agency forms]

c: Agency Personnel File

West Virginia Division of Personnel

[OPTIONAL LANGUAGE ‐ If the employer meets with the employee and hand delivers the letter, the

employer may request that the employee verify receipt by signing the following acknowledgment

typed at the bottom of the letter.]

I have received a copy and am aware of the contents of the foregoing letter

___________________________________

__________________

Employee Signature

Date

Sample - Continuous Absence - Exhaustion Of Paid Leave - No Communication Page 3