[Date]

MEMORANDUM

TO:       Mollie Anderson, Director
            Department of Administrative Services –

Human Resources Enterprise

FR:       xxxxx xxxxxxxx, 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:

Cutoff Date:

(Attach "model" of "RETENTION POINT CALCULATION WORKSHEET" (CFN 552-0106) for each class being evaluated.)

Please call me at ________________ you have any questions.

c:  Governor's Office