MASSACHUSETTS CIVIL SERVICE COMMISSION – DISCIPLINE APPEAL FORM
Name of Person Filing Appeal Name of Government Agency
(A
ppellant): That Imposed Discipline (Respondent):
Appellant Street
or P.O.
Box: Respondent Street or P.O.
Box:
Appellant City, State, Zip Code: Respondent City, State, Zip
Code:
Appellant Contact Phone Number: Respondent Contact Phone Number:
Appellant Email Address: What is your current title or position?:
What discipline was imposed against you?
When did you receive the notice of decision regarding the discipline?
Are you alleging that the Respondent failed to follow any procedural requirements?
Have you ever filed an appeal with the Civil Service Commission before?
REQUIRED NEXT STEPS BY APPELLANT
1. Attach a check or money order in the amount of $50.00 made payable to the Civil Service Commission.
2. Attach a copy of the written notice of decision to discipline you that you received from the Respondent.
3. Mail or
hand-deliver this appeal form to the Civil Service Commission at One Ashburton
Place: Room 503, Boston, MA 02108 within ten (10) business days of receiving the
notice of decision by the Respondent. (For those appeals received via mail, the postmark date will be
used to determine if the appeal is timely.)
4. Mail or hand-deliver a copy of this discipline appeal form to the Respondent.
WHAT HAPPENS AFTER THE COMMISSION RECEIVES YOUR APPEAL FORM?
1. Within ten (10) days, you and the Respondent will receive an Acknowledgment Form from
the Commission along with a “Notice of Pre-Hearing Conference”. The pre-hearing
conference is usually held within thirty (30) days from the time the Commission received
your appeal.
2. You and the Respondent are required to attend the Pre-Hearing Conference at which time a
member of the Commission will provide further details about how your appeal will proceed.
SIGNATURE OF APPELLANT:
TODAY’S DATE:
CSC Discipline Appeal Form Rev. 9/23/13
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signature
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