Form 1- Request for Decision Review
REQUEST FOR DECISION REVIEW
To all staff seeking review of an administrative decision: this form is provided by the Agency in order to assist in the filing of a request to review a decision and to simplify compliance with the provisions of Staff Rule 111.2
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To: UNRWA Field Office Director (for Field staff) □
or
To: Director of Human Resources, HQ Amman (for HQ staff) □
PERSONAL INFORMATION
Mr. / Mrs. / Ms.
Your Name (family name first) ______
E-mail address ______
Mailing Address ______
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Work Phone ______
Home Phone ______
Mobile Phone ______
Index or Employee Number ______
Type of Appointment______Functional Title______
Dept./Office______Duty Station______
ADMINISTRATIVE DECISION TO BE REVIEWED
Specify the decision you are requesting us to review (please attach a copy of the decision, if any)
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When was the decision taken/when did you become aware of it? ______
Who took the decision? ______
Have you discussed the matter with your supervisor(s)/ the decision maker?______
If so, when? ______
Have you received a response? ______
PURPOSE OF YOUR REQUEST
What staff rights of yours have been violated by the decision at issue? ______
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What remedy do you seek through this decision review? ______
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Would you be willing to participate in an informal resolution of this matter (example: through mediation)? ______
Please feel free to attach a letter containing your description of the context of the decision, relevant facts, documents and any other information you consider important in the context of your request for evaluation.
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COUNSEL INFORMATION
If you have, or should you decide in the future to obtain legal counsel, please provide us with the following contact information:
Name of Counsel ______
Place of work ______
E-mail Address ______
Mailing address ______
Work Phone ______Mobile Phone______Fax______
Signature: ______ Date: ______
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