Arizona State Personnel System
ADOA DISCIPLINE/DISMISSAL CHRO REVIEW DOCUMENT
Agency Information
Agency Name
Manager
Requesting Action
Manager's Phone
Date
Number
Employee Information
Employee
EIN
Name
Uncovered
Covered
FLSA Exempt
FLSA Non-Exempt
If employee is AZ POST certified, were applicable notice rights provided to the employee
Yes
No
prior to any investigative interview (see A.R.S. § 38-1104).
Job
Hire
Title
Date
Supervisor's
Name
Suspension of greater than 80 working hours
Demotion
Dismissal
Action Agency is Pursuing
Review Information
An agency head may issue to an employee a Letter of Reprimand or impose a suspension of 80 working
hours or less without ADOA review. Suspensions of greater than 80 working hours, involuntary demotions,
and dismissals require agency heads to submit the proposed action to ADOA for review before administering the action.
The CHRO shall review the ADOA Discipline and Dismissal Guidance Worksheet prior to submitting your request for
review to the ADOA Human Resources Division.
I have reviewed the ADOA Discipline and Dismissal Review Guidance worksheet. I have provided the agency head my
recommendation.
CHRO Signature
Date
Submit this review form and the letter you intend to issue to the employee to HumanResources@azdoa.gov. You may
also send a copy to your ADOA Shared Services Officer.
ADOA HRD USE ONLY
Signature of
Date
Second Reviewer
Date Agency Contacted
ASPS/HRD-FA8.01 5/20
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