MASSACHUSETTS CIVIL SERVICE COMMISSION – REQUEST FOR EQUITABLE RELIEF (NON-BYPASS)
Name of Person Fili
ng Appeal
(Appellant):
City, Town or State Agency whose action or
inaction you are appealing (Respondent):
Appellant Street or
P.O. Box:
Respondent Street or P.O. Box:
Appellant City,
State, Zip Code:
Appellant Contact P
hone Number:
Appellant Email
Address:
Brief Statement of the action or inaction that you are appealing (Attach a separate page if needed):
REQUIRED NEXT STEPS BY APPELLANT
1. Attach a check or money order in the amount of $75.00 made payable to: Civil Service Commission.
2. If applicable, attach a copy of the written decision or other correspondence 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. (For those appeals received via mail, the postmark date will be
used to determine the receipt date with the Commission.)
4. Mail or hand-deliver a copy of this 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 Equity (Non-Bypass) Appeal Form Rev. 5/27/16
Respondent City, State, Zip Code:
Have you ever filed an appeal with the Commission before?
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