Form I-766 - Personnel System Consolidated Appeal/dispute Form - State Of Colorado
Download a blank fillable Form I-766 - Personnel System Consolidated Appeal/dispute Form - State Of Colorado in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form I-766 - Personnel System Consolidated Appeal/dispute Form - State Of Colorado with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2COLORADO STATE PERSONNEL SYSTEM CONSOLIDATED APPEAL/DISPUTE FORM
This consolidated form is provided for employees and/or job applicants who are filing appeals or disputes with the State
Personnel Board or State Personnel Director. A copy of the Board Rules and Director's Administrative Procedures may
be found at
or
PLEASE READ THE INSTRUCTIONS provided for completing the Consolidated Appeal/Dispute form. The form may be
printed out and filled in by hand or completed on-line and saved to your personal drive and printed out. You may attach
additional sheets if necessary, but please note which numbered question the information on the additional sheets
applies to. Pursuant to the Americans with Disabilities Act, accommodations for completing the form are available.
Contact the State Personnel Board for assistance at 303-866-3300.
Mail or hand-deliver the completed form to the State Personnel Board, 1525 Sherman Street, 4th Floor, Denver, CO
80203, or fax it to 303-866-5038. YOU MUST NOTIFY the Board or Director in writing if the information below changes
before the appeal or dispute process is concluded. NOTE: You will receive copies of Board Orders by email ONLY, and
therefore, providing an email address is mandatory. If you do not have access to email or a computer, you must request
an exemption in writing from the Board.
1. IDENTIFICATION OF EMPLOYEE/JOB APPLICANT (COMPLAINANT)
Name: _____________________________________________________________________________________________
Address:____________________________________________________________________________________________
Phone: (w) _____________________________________ (h)_________________________________________________
*Email: (REQUIRED) _________________________________________________________________________________
I am/was a certified state employee. Yes
No
I am/was a probationary employee. Yes
No
2. Have you retained an attorney to assist you in this matter? Yes
No
If so, please provide the following
information for your attorney.
Name: _______________________________________________________________________________________________
Address:______________________________________________________________________________________________
Phone: _______________________________________________________________________________________________
Fax: _________________________________________________________________________________________________
*Email: (REQUIRED)____________________________________________________________________________________
3. THE PARTY (DEPARTMENT/COLLEGE) WHOSE ACTION IS BEING APPEALED OR DISPUTED (RESPONDENT)
Name: _______________________________________________________________________________________________
Department:___________________________________________________________________________________________
Address:______________________________________________________________________________________________
4. SPECIFIC ACTION(S) BEING APPEALED OR DISPUTED and REASON(S) FOR APPEAL/DISPUTE
5. Were you notified in writing that this action was taken? Yes
No
Date you received notification. _________
If verbal, describe below. You must attach a copy of any written notification of the action that was provided to you.
_______________________________________________________________________________________________________
6. RELIEF REQUESTED (What do you want as a result of this appeal?)
Page 1 of 2, Revised 08/2014
ADVERTISEMENT
0 votes
Related Articles
Related forms
Local Government Limited Gaming Impact Fund (lglgif) Cost Recovery Form -state Of Colorado Department Of Local Affairs
Legal
Colorado Universal Service Charge Payment Notice Template - Quarter 2001 - State Of Colorado Department Of Regulatory Agencies
Legal
Related Categories
Parent category: Legal