Fillable Appeal Of Minor Disciplinary Action printable pdf download

APPEAL OF MINOR DISCIPLINARY ACTION

NEW JERSEY CIVIL SERVICE COMMISSION - STATE SERVICE

INSTRUCTIONS:

Employer: Provide this form to all permanent employees or employees serving in a working test period with the

issuance of any notice of suspension or fine of five days or less or an official written reprimand.

Employee: To appeal this charge, complete Part 1 and submit this form to your appointing authority/designee

within five calendar days of receipt of this form or within such time frame as provided in your union contract.

PART 1 - Employee Appeal to Management:

NAME OF EMPLOYEE:

MAILING ADDRESS:

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SOCIAL SECURITY NUMBER:

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DIVISION, INSTITUTION, OR AGENCY:

TITLE OF YOUR POSITION:

DEPARTMENT:

Charges Appealed:

REPRESENTATION (Check One)

I will represent myself

My representative will be:

Name:

Title/Union:

Penalty Recommended:

Employee

Signature:

Date:

EMPLOYEE DO NOT WRITE IN PART II - For Management Decision

Part II - Management Decision on Employee’s Appeal:

MANAGEMENT

Appointing Authority/

Check here if

Date:

Designee Signature:

decision is attached.

Section Below to be Completed by Employee After Management Decision

Part III - Further Appeal:

If the charges have been upheld by Management in Part II, you have a further right to appeal. Please check block A, B, or C below to

indicate your decision with respect to further appeal and return this form to the appointing authority/designee. Please note, if you are a permanent employee in a

Law Enforcement Unit and have selected option B, submit this form to your union president.

I will not appeal the management decision.

I wish to appeal this minor discipline under the provisions of my union contract. This option is available only to permanent employees

covered by a union contract who receive a fine or suspension of five days or less. Check union contract for time period to file appeal.

I request a review of my appeal by the New Jersey Civil Service Commission. This option is available to permanent employees or

employees serving in a working test period who receive a fine or suspension of five days or less or an official written reprimand. This

appeal must be filed within 20 calendar days of receipt of this form and present an issue of general applicability concerning a law, rule,

regulation or policy.

Employee Signature:

Date:

DPF-335 / Revised 8-10-09

Distribution: Original for Employee Record, Employee Copy, Management Copy, Employee Representative.

Appeal Of Minor Disciplinary Action

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