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