Hearing Appeals Form
Appellant Information
First Name
Last Name
Work Phone
Phone #
Address
City
State
Zip Code
Denvergov Email
Required regardless of employment status
Personal Email
Agency Employed By
Employee ID
Department
Preferred Method of Communication?
Denvergov
Personal
Employment Status
Career Status
Probationary
On Call\Seasonal
Former Employee
Other
Other
1. Direct Appeal
a. Appeal Action
[See CSR 19-20 A. 1 or 20-20 A.1 for DSD] Check only those that apply.
Dismissal
Suspension or temporary reduction in pay
Disqualification
Layoff
Whistleblower violation* (Complete e, f, & g below.)
Involuntary demotion with an attendant loss of pay
b. Date of Agency Action
c. Action checked above involved discrimination or harassment based on
Age
Color
Creed
Disability
Gender Identity and Expression
Genetic Information
Marital Status
Military Status
National Origin\Ancestry
Other protected status under federal, state and/or local law
Political Affiliation
Pregnancy or Related Condition
Race
Religion
Sex
Sexual orientation
Transgender Status
d. Action checked above involved retaliation based on [protected activity under CSR 16-22]
Identify Agency retaliatory action or threat of retaliatory action
e. Identify the official misconduct you reported
[DRMC 2-107(d)]
f. When and to whom did you report the official misconduct?
[DRMC 2-107(a)]
g. What was the adverse employment action or threat of adverse action taken by Agency and when did it occur?
[DRMC 2-107(a)]
2. Appeal of Complaint or Grievance [CSR 19-20 B]. Attach complaint, grievance and Agency's response.
a. Grievance resulting in violation of
[Section of CSR, Charter, or ordinance]
Identify Agency action that violated above rule(s):
b. Describe how Agency action affected your pay, benefits or status
[§19-20 B.3]
c. Date of my complaint or grievance:
d. Date of Agency response:
3. Reason For Appeal
4. Remedy Sought
Are you interested in mediating this appeal?
Yes
No
Are you representing yourself?
Yes
No
Representative Information
Rep First Name
Rep Last Name
Rep Phone
Rep Email
Rep Bar Registration Number
Please attach your Notice of Discipline or Grievance. If you have additional documents you would like to submit please e-mail them to
csahearings@denvergov.org
When you press "Submit" below, your Appeal will be sent to the Career Service Hearing Office.
If you have any questions please contact us at 720-913-5703 or e-mail us at
csahearings@denvergov.org
.
Contact Information