MASSACHUSETTS CIVIL SERVICE COMMISSION – (;$0,1$7,21 APPEAL FORM
N
ame of Person Filing Appeal
(Appellant): Civil Service Examination Date:
A
ppellant Street
or P.O.
Box:
Civil Service Title for which you were tested:
A
ppellant City,
State, Zip Code: Have you ever filed an appeal with the Commission before?
A
ppellant Contact Phone Number:
A
ppellant Email Address:
Brief Statement of the allegations that were presented to the state's Human Resources Division for review:
R
EQUIRED NEXT STEPS BY APPELLANT
1. Attach a check or money order in the amount of $25.00 (for original appointment exams) or $75.00
(for promotional appointment exams) made payable to: Civil Service Commiss
ion.
2. Attach a copy of the written decision from the state's Human Resources Division (HRD).
3. Mail or hand-deliver this appeal form to the Civil Service Commission at One Ashburton
Place: Room 503, Boston, MA 02108 within seventeen calendar days after the date of the mailing of
the decision by HRD. (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 examination appeal form to HRD at: Human Resources Division; 100
Cambridge Street, Suite 600, Boston, MA 02114.
W
HAT HAPPENS AFTER THE COMMISSION RECEIVES YOUR APPEAL FORM?
1. W
ithin ten (10) days, you and HRD 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
y
our appeal.
2. You and HRD are required to attend the Pre-Hear
ing 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 Examination Appeal Form Rev. 9/18/13
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