HomeMy WebLinkAboutMerit Appeals Board Appeal FormDate received:
Appeal to the
Merit Appeals Board
101 Pauahi Street, Suite 2
Hilo, Hawaii 96720-4224
Submit original plus eight (8) copies of the form to the above address. Do not email this form.
Use black ink or a typewriter to complete this form. Use additional pages as necessary.
1. Name, address, and telephone number of the 2. Name, address, and telephone number of
appellant: appellant's authorized representative (if any):
Is the appellant a County employee? ❑Yes ❑No
3. Name of the mayor, the director of human 4. Pursuant to §76-14, this appeal is being
resources, or appointing authority or a designee filed for an action under the following
acting on behalf of one of these individuals category (check all applicable):
whose action is being appealed:
5. Date action taken:
6. Date notice of action was received by appellant
❑ Recruitment and Examination
❑ Classification or reclassification of a
particular position
❑ Initial pricing of class (of work)
❑ Employment action taken under
Chapter 76, HRS (appellant must be a
civil service employee excluded from
collective barizainino)
7. Statement of the legal wrong caused by the action of the mayor, director of human
resources, or an appointing authority, or a designee acting on behalf of one of these
individuals, or a statement as to how such action has adversely affected or aggrieved the
appellant. Include a concise statement of the facts pertinent to this appeal.
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8. Other facts relevant to this appeal:
9. Remedy requested with reasons and explanation of the legal basis by which remedy should be
granted:
10. I would like to have my appeal heard in a meeting: ❑ open to the public
❑ closed to the public
This is to certify that to the best of my knowledge, information, and belief, every statement contained
herein is true, and no statement is misleading nor interposed for delay.
Signature of appellant Date
If appellant has a representative:
Signature of appellant's representative Date
Submit original and eight (8) copies of this appeal form to:
Merit Appeals Board
101 Pauahi Street, Suite 2
Hilo, Hawaii 96720-4224
Rules of the Merit Appeals Board provide as follows:
§104-2 Filing an appeal. (a) Appeals shall be filed within twenty calendar days from
the action giving rise to the appeal, provided, if use of an internal complaint procedure,
pursuant to Hawaii Revised Statutes §76-42, is required prior to filing an appeal with the
Board, the appeal to the Board shall be filed within twenty calendar days from a decision
rendered at that step in the internal complaint procedure immediately preceding the filing
of the appeal to the Board. Appeals from an administrative review of the director under
Title I of the rules of the Department of Human Resources shall be filed within twenty
calendar days from the director's decision.
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