Complaint/Appeal Form | Personnel Board

Covered Employee

Yes

No

Filing an

Appeal

Complaint

Disciplinary Action

Date of Discipline/Reprisal

Agency

First Name

Last Name

Street Address

City

State

Zip

Home Phone #

Cell Phone #

Email Address

Description

In a brief and concise manner, please state the reason you are filing this appeal/complaint by explaining why the allegations against you (appeal) or the prohibited personnel practice taken against you (whistleblower complaint) must be heard by the Arizona State Personnel Board.

E-Signature

I Agree

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