[Date]

MEMORANDUM

TO:       Mollie Anderson, Director

Department of Administrative Services –

Human Resources Enterprise

FR:       xxxx xxxxxxxxx, Director

Department of XYZ

RE:       Proposed Layoff

Due to ______________________, it will be necessary to institute a layoff in the Department of

____________________.  In accordance with 11 IAC 60.3, your approval of the following plan is

requested:

Effective Date:

Organizational Unit:

Job Classification:

Number of Employees to be Laid Off:

Affected Employees:

Date of Meeting with the Union:

Please call me at ______________ if you have any questions.

c:  Governor's Office