OHR 81

Introduction
Part A and Part B
Part C
Part D and Part E
Signature
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STATE OF CALIFORNIA

Merit Issue Complaint

DGS OHR 81 (10/2021)

Use this form to file a merit issue complaint with the Department of General Services (DGS). Information requested on the Merit Issue Complaint Form is used by the Office of Human Resources to research alleged acts that may violate the State’s merit system. It is extremely important for the DGS applicant/employee to complete this form thoroughly and as accurately as possible. It is recommended that the DGS applicant/employee retain a copy for their records.

SEND THIS FORM AND ANY SUPPORTING DOCUMENTATION TO:

OHRSpecialRequests@dgs.ca.gov

OR BY MAIL TO:

Department of General Services

Attn: Chief, Office of Human Resources and

Personnel Officer, Office of Human Resources

707 3rd Street, Suite 7-130

West Sacramento, CA 95605

STATE OF CALIFORNIA

Merit Issue Complaint

DGS OHR 81 (10/2021)

PART A –DGS APPLICANT/EMPLOYEE INFORMATION

LAST NAME

FIRST NAME

M.I.

CLASSIFICATION TITLE

DIVISION/OFFICE/UNIT

MAILING ADDRESS (Street or P.O. Box, City, State, ZIP)

PART B –ALLEGED ACT INITIATED BY

LAST NAME

FIRST NAME

CLASSIFICATION TITLE

DIVISION/OFFICE/UNIT

REQUEST FOR PERSONNEL ACTION (RPA) NUMBER

JOB CONTROL (JC) NUMBER (located in the job posting)

STATE OF CALIFORNIA

Merit Issue Complaint

DGS OHR 81 (10/2021)

PART C –TYPE OF MERIT ISSUE COMPLAINT (CHECK ALL THAT APPLY)

Interference with Promotional Opportunity

Interference with access to any Board appeals process

Designation of managerial position

Dispute regarding the effective dates of appointment or promotion

Discrimination due to political affiliation or opinion

Other

Brief Description

STATE OF CALIFORNIA

Merit Issue Complaint

DGS OHR 81 (10/2021)

PART D –DESCRIPTION OF COMPLAINT

Provide a detailed description of the alleged act:

PART E –SUPPORTING DOCUMENTATION/ATTACHMENTS

List any supporting documentation or attachments that you are including with your complaint:

STATE OF CALIFORNIA

Merit Issue Complaint

DGS OHR 81 (10/2021)

Signature

Scribble Signature

Date

Signature

STATE OF CALIFORNIA

Merit Issue Complaint

DGS OHR 81 (10/2021)

SEND THIS FORM AND ANY SUPPORTING DOCUMENTATION TO:

OHRSpecialRequests@DGS.ca.gov

OR BY MAIL TO:

Department of General Services

Attn: Chief, Office of Human Resources and

Personnel Officer, Office of Human Resources

707 3rd Street, Suite 7-130

West Sacramento, CA 95605

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