"Disciplinary Action or Demotion Request Form" - Florida

This "Disciplinary Action or Demotion Request Form" is a Florida-specific form released by the Florida Department of Juvenile Justice on September 1, 2016.

Download the form by clicking the link below, fill it out by hand, and mail it as per the guidelines provided by the department or the applicable legal instructions.

ADVERTISEMENT

Download "Disciplinary Action or Demotion Request Form" - Florida

140 times
Rate
4.4(4.4 / 5) 8 votes
Department of Juvenile Justice
DISCIPLINARY ACTION OR DEMOTION REQUEST
DATE: ___________________________
TO BE COMPLETED BY THE PROGRAM OFFICE
EMPLOYEE’S NAME: ________________________________________________ PF ID#: ______________________
CIRCUIT/REGION/OFFICE CONTACT PERSON: ____________________________ Phone: ______________________
EMPLOYEE’S SUPERVISOR: ___________________________________________ Phone: ______________________
EMPLOYEE’S STATUS:
Probationary
Permanent Career Service (CS)
Selected Exempt Service (SES)
Has employee been moved from client contact?
Yes
No
Is an I.G. investigation pending?
Yes
No
REASON FOR DISCIPLINARY ACTION or DEMOTION: (
If the action is a suspension, state the number of days to be suspended.)
TO BE COMPLETED BY THE HUMAN RESOURCES
BRIEF DESCRIPTION OF EMPLOYEE HISTORY: (
Please obtain necessary information from the Bureau of Human Resources at HR
Disciplinary History Request.)
1. Length of Service with State of Florida: ______ Years _______ Months
2. Length of Service with DJJ:
______ Years _______ Months
3. Last Three Evaluations (Overall): Provide copies from the official Human Resources Personnel file.
4. Counseling and Disciplinary History: Provide copies from official The Human Resources Personnel file.
Completed by: ________________________________
Date Completed: _____________________
(Please return completed form to the requesting office.)
Requestor – Please forward completed form and all documents furnished by the Bureau of Human Resources, receipt
of policies violated, copies of policy/policies violated, copy of draft predetermination letter, and any other relevant
material to the General Counsel’s Office.
Revised 09/16
Reset/Clear Form
Save As
Print Form
Department of Juvenile Justice
DISCIPLINARY ACTION OR DEMOTION REQUEST
DATE: ___________________________
TO BE COMPLETED BY THE PROGRAM OFFICE
EMPLOYEE’S NAME: ________________________________________________ PF ID#: ______________________
CIRCUIT/REGION/OFFICE CONTACT PERSON: ____________________________ Phone: ______________________
EMPLOYEE’S SUPERVISOR: ___________________________________________ Phone: ______________________
EMPLOYEE’S STATUS:
Probationary
Permanent Career Service (CS)
Selected Exempt Service (SES)
Has employee been moved from client contact?
Yes
No
Is an I.G. investigation pending?
Yes
No
REASON FOR DISCIPLINARY ACTION or DEMOTION: (
If the action is a suspension, state the number of days to be suspended.)
TO BE COMPLETED BY THE HUMAN RESOURCES
BRIEF DESCRIPTION OF EMPLOYEE HISTORY: (
Please obtain necessary information from the Bureau of Human Resources at HR
Disciplinary History Request.)
1. Length of Service with State of Florida: ______ Years _______ Months
2. Length of Service with DJJ:
______ Years _______ Months
3. Last Three Evaluations (Overall): Provide copies from the official Human Resources Personnel file.
4. Counseling and Disciplinary History: Provide copies from official The Human Resources Personnel file.
Completed by: ________________________________
Date Completed: _____________________
(Please return completed form to the requesting office.)
Requestor – Please forward completed form and all documents furnished by the Bureau of Human Resources, receipt
of policies violated, copies of policy/policies violated, copy of draft predetermination letter, and any other relevant
material to the General Counsel’s Office.
Revised 09/16
Reset/Clear Form
Save As
Print Form
ADVERTISEMENT
Fill PDF online