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Written Petition for Appeal

A petition for appeal made without the use of the approved form must be in writing and contain the following:

  • Name of employee and name of the agency that took action
  • Type and effective date of the action taken by the agency
  • Name, address, and telephone number of the employee’s representative, if any
  • Employee’s address and telephone number
  • A statement as to whether the employee or anyone acting on his or her behalf has filed an appeal under any negotiated review procedure pursuant to a collective bargaining agreement, or has filed a complaint with any other agency regarding this matter
  • Identity of the collective bargaining unit (if any) of which employee is a member
  • Signature of the employee and his/her representation, if any