Employee Disciplinary Action Appeal Form And Request For Board Of Review Form Page 3

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Date Received by CEO __________________
Findings and Decision of CEO:
_____________________________________________________________________________________
Chief Executive Officer’s Signature
Date
I accept this decision.
I want to appeal this decision to the Board of Review.
IT IS YOUR RESPONSIBIILTY TO CONTACT HUMAN RESOURCES AND REQUEST TO CONTINUE YOUR
APPEAL. Appeals must be requested within 7 days of the CEO’s decision.
Employee’s Signature and Date: _______________________________________________________
Received by HR staff __________________________________ on this date ___________________
Board of Review
Board of Review Findings and Decision:
__________________________________________
________________________
BOR Member Signature
Date
__________________________________________
________________________
BOR Member Signature
Date
__________________________________________
________________________
BOR Member Signature
Date
PINE CREEK INDIAN RESERVATION
1485 MNO-BMADZEWEN WAY • FULTON, MI 49052

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