HTML Preview Notice Of Disciplinary Action Form page number 1.
State of Maryland
Department of Budget and Management
Office of Personnel Services and Benefits
301 West Preston Street
Baltimore, Maryland 21201
NOTICE OF DISCIPLINARY ACTION
To Employ
ee: You or your representative may appeal this disciplinary action to the Cabinet Secretary of
your department (if your agency is not headed by a Cabinet Secretary, appeal must be
made to the agency head). The appeal must
be in writing and filed within 15 calendar days
after your receipt of this written notice.
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To Agency: COMPLETE IN DUPLICATE. Give one copy to the employee; and retain one copy for
your files. Please do not send copy to Department of Budget and Management.
This action m
ust be processed via the DBM Office of Personnel Services and
Benefits electronic Statewide Personnel System (SPS).
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Name of Employee
Classification
SPS Employee ID No.
Check appropriate box and complete:
Pursuant to Title 11, subtitle 1 of the State Personnel and Pensions Article, and COMAR 17.04.05.04, the above-
referenced employee:
through
work
days from
.
.
is denied an annual pay increase effective
is demoted to
at , effective .
(Classification)
(Salary Level)
DATE OF
INCIDENT THAT PROMPTS THIS DISCIPLINE:
.
DATE WHEN INCIDENT WAS DISCUSSED WITH THE EMPLOYEE:
Explain what the employee did that merits disciplinary action (state the fa
c
.
ts): (Attach pages
as necessary)
Cite the law(s), regulation(s), or policy(ies) violated:
Copy to Empl
oyee:
In Person Mailed to:
(Date)
______________________________________
(Date) (Name of Department) (Name and Signature of Appointing Authority)
MS-4A (Revised 9/16)
is reprimanded.
forfeits
Annual Leave days.
is suspended without pay for