NOTICE OF APPEAL

[DATE]

[NAME OF APPEAL AUTHORITY]

I, [NAME OF EMPLOYEE] am hereby appealing against a disciplinary action imposed on [DATE] at [PLACE].

I attach a copy of the notice of the disciplinary enquiry and/or the written warning.  [THE APPEAL REQUEST IS NOT VALID UNLESS THESE DOCUMENTS ARE ATTACHED.]

My reasons for appeal are :

The desired outcome of the appeal is :

I wish/do not wish/ [CHOOSE ONE] to provide additional evidence not available at the time of the disciplinary proceeding.

SIGNATURE OF EMPLOYEE

DATE

[PERSONAL DETAILS OF THE EMPLOYEE]