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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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