Grievance Form - AFSCME

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Grievance Form - AFSCME

AFSCME LOCALSTEPOFFICIAL GRIEVANCE FORMNAME OF EMPLOYEECLASSIFICATIONWORK LOCATIONTITLEIMMEDIATE SUPERVISORDEPARTMENTSTATEMENT OF GRIEVANCE:List applicable violation:Adjustment required:I authorize the A.F.S.C.M.E. Localas my representative to act for me in the dispositionof this grievanceDateSignature of EmployeeSignature of Union RepresentativeTitleDate Presented to Management RepresentativeSignatureTitleDisposition of Grievance:THIS STATEMENT OF GRIEVANCE IS TO BE MADE OUT IN TRIPLICATE. ALL THREE ARE TO BESIGNED BY THE EMPLOYEE AND/OR THE AFSCME REPRESENTATIVE HANDLING THE CASE.ORIGINAL TOCOPYCOPY: LOCAL UNION GRIEVANCE FILENOTE: ONE COPY OF THIS GRIEVANCE AND ITS DISPOSITION TO BE KEPT IN GRIEVANCEFILE OF LOCAL UNION.THE AMERICAN FEDERATION OF STATE, COUNTY AND MUNICIPAL EMPLOYEESF29


GRIEVANCE FACT SHEETThis form is to be used by the steward to aid in investigating a grievance. The FACT SHEET outlines the information that will be necessaryto develop a strong case. Use additional pages to document all the details.DO NOT TURN THIS FORM INTO MANAGEMENT. THIS INFORMATION IS FOR THE UNION'S USE ONLY.GRIEVANT_______________________________DEPARTMENT___________________________________CLASSIFICATION_________________________DATE OF HIRE___________________________________DATE OF CLASSIFICATION_________________WORK LOCATION________________________________What Happened? Also describe incidents which gave rise to the grievance.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Who was involved? Give names and titles (include witnesses)______________________________________________________________________________________________________________________________When did it occur? Give day, time, date(s)_______________________________________________________________________________________________________________________________________________Where did it occur? Specific locations___________________________________________________________________________________________________________________________________________________Why is this a grievance? What is management violating: contract, rules and regulations, unfair treatment,existing policy, past practice, local, state, federal laws, etc.___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What adjustment is required? What must management do to correct the problem?__________________________________________________________________________________________________________________________________________________________________________________Additional comments. Use reverse side if needed___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________GRIEVANT'S SIGNATURE__________________________ ________DATE____________________________STEWARD__________________________________DATE____________________________GRIEVANT'S HOME ADDRESS_______________________________________________________________NOTE: A COPY OF THIS FORM TO BE COMPLETED BY STEWARD OR OFFICER FILING GRIEVANCEAND TO BE TURNED IN TO LOCAL GRIEVANCE FILE ALONG WITH COPY OF GRIEVANCE ANDDISPOSITION.THE AMERICAN FEDERATION OF STATE, COUNTY AND MUNICIPAL EMPLOYEESF 29A

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