What is it used for?
This form is used to inform an employee of a disciplinary action and/or a non-disciplinary involuntary disability separation.
- Order of Removal
- Involuntary Disability Separation
Who uses this form?
This form is completed by the employer.
How to complete the form.
Instructions and a checklist on how to complete the O.R.C. 124.34 Order/Order of Involuntary Disability Separation (ADM 4055) form are provided when you download the form. If you have difficulty downloading the form, please contact SPBR at (614) 466-7046.