Grievance
Form
Communication Workers of America
Local 9431
161 Palm Avenue, Suite 1, Auburn, California 95603
Phone: 530-823-9431 Fax:
530-823-0239
(This form to be filled out by the Grievant and will be sent to the Union
Steward; be sure to read
the
paragraph at
the bottom of the page.) (Important: Sign and date
the form accordingly.)
Please Print Legibly
Grievant’s Name:____________________ Supervisor:___________________________
Job Title:______________________ Shift:______ Pay Rate:______________________
NCS Date:_________________ Occurrence Date:_____________________
Home Address___________________ Work
Address:___________________________
_________________________________ ________________________________
Phone:________________________ Phone or V.M_____________________________
E-Mail: ______________________________ _ Pager:____________________________
Statement Of Grievance:___________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Attach
additional Pages if necessary:
By
Submitting this you authorize any certified CWA representative
to have copies of any of your records that
may
affect
your condition of employment. This includes medical records or opinions,
security reports or any records
necessary and relevant to protect your
rights under the collective bargaining agreement and any labor laws that apply
Signed___________________________________ Date:__________________