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Date received: <br />Appeal to the <br />Merit Appeals Board <br />101 Pauahi Street, Suite 2 <br />Hilo, Hawaii 96720-4224 <br />Submit original plus eight (8) copies of the form to the above address. Do not email this form. <br />Use black ink or a typewriter to complete this form. Use additional pages as necessary. <br />1. Name, address, and telephone number of the 2. Name, address, and telephone number of <br />appellant: appellant's authorized representative (if any): <br />Is the appellant a County employee? ❑Yes ❑No <br />3. Name of the mayor, the director of human 4. Pursuant to §76-14, this appeal is being <br />resources, or appointing authority or a designee filed for an action under the following <br />acting on behalf of one of these individuals category (check all applicable): <br />whose action is being appealed: <br />5. Date action taken: <br />6. Date notice of action was received by appellant <br />❑ Recruitment and Examination <br />❑ Classification or reclassification of a <br />particular position <br />❑ Initial pricing of class (of work) <br />❑ Employment action taken under <br />Chapter 76, HRS (appellant must be a <br />civil service employee excluded from <br />collective barizainino) <br />7. Statement of the legal wrong caused by the action of the mayor, director of human <br />resources, or an appointing authority, or a designee acting on behalf of one of these <br />individuals, or a statement as to how such action has adversely affected or aggrieved the <br />appellant. Include a concise statement of the facts pertinent to this appeal. <br />Page 1 <br />