State Employee Grievance Procedure
State Appeal Form

TO APPEAL THE DECISION OF THE AGENCY CONCERNING A GRIEVANCE UNDER THE STATE EMPLOYEE GRIEVANCE PROCEDURE ACT TO THE STATE HUMAN RESOURCES DIRECTOR, THE EMPLOYEE AND/OR REPRESENTATIVE INITIATING THE APPEAL MUST COMPLETE THIS FORM AND RETURN IT TO THE STATE HUMAN RESOURCES DIVISION.

Employee's Name:  

Job Classification:  

Agency:  

Home Address 
Street: 
City: 
State: 
Zip Code: 
E-mail Address:

Telephone Area Code Number
Home:
Office:
Cell:

1. Has the employee completed twelve (12) months of satisfactory service with the state? Yes No   

2. What disciplinary action taken against the employee is being appealed?    

3. Has the employee received a final decision from the agency? Yes No   

4. What date did the employee receive the final decision?

5. If the employee has not received a final decision from the agency, what date did the employee initiate the grievance within the agency's internal grievance procedure?    

APPEAL

Please specify why the employee contends that the agency's decision concerning the grievance is unfair and state relevant facts and issues to support that position:   

Please specify the relief that the employee is seeking by this appeal:   

Additional documents may be submitted by e-mail to the following address -- grievance@ohr.sc.gov -- or by mailing the documents to: Human Resources Division, 8301 Parklane Road, Suite A220, Columbia, SC 29223.

Form GC101-Revised 07/01/2005