State Form 922 - Submission To Indiana State Employee Suggestion Program

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FOR OFFICE USE ONLY

SUBMISSION TO INDIANA STATE

EMPLOYEE SUGGESTION PROGRAM

State Form 922 (R4 / 1-00)

Name(s)

Agency / division / work unit

Work address (building, number, street, city, state, ZIP code)

Work telephone number

Position / title

(

)

Agency with authority to implement your suggestion

Subject of your suggestion:

Descibe the present situation which will be affected by your suggestion

Describe your proposed solution and benefits (continue on back and / or attach additional sheet(s), if necessary)

The State of Indiana encourages and rewards state employees whose innovative ideas improve efficiency and effectiveness of government and provides

state managers with a tool to recognize employees whose creative ideas have improved the way we do business.

It is understood and agreed that the State of Indiana’s only obligation to me upon receiving and adopting this suggestion shall be determined solely by the

terms and the rules of the Indiana Employee Suggestion Program in effect on the date of receipt of this suggestion by the State Personnel Department.

Your signature

Date (month, day, year)

Thank you for exercising your power of Suggestion!

Please allow 90 days for processing this suggestion. Direct any questions to the Suggestion Coordinator in the State Personnel Department at

(317) 233-5519.

Sign the completed form and mail to:

Special Projects, State Personnel Department, 402 West Washington, Room W161, Indianapolis, Indiana 46204