GRIEVANCE APPEAL FORM. Xxxxxxxx's Name Contact Telephone Work Telephone Xxxxxxxx’s Mailing Address City Zip Code _ Name of Xxxxxxxx's ADFAC Representative (if any) Grievant's Work Location: [ ] CC [ ] FC [ ] NOCE Division: Dept/Area: Name of Management Supervisor : INDICATE THE LEVEL OF GRIEVANCE APPEAL: [ ] LEVEL TWO - President/Xxxxxxx [ ] LEVEL THREE - Vice Chancellor, Human Resources REASON FOR APPEAL: Indicate the specific reason(s) for requesting an appeal of this grievance. REMEDY REQUESTED: State the specific action(s) requested of the District which you believe will resolve the grievance. Attach additional pages as necessary. Xxxxxxxx's Signature: Date: DISTRICT RESPONSE TO GRIEVANCE: Attach additional pages as necessary. Authorized District Signature: Date: Notice to Grievant: If you are not satisfied with this response and wish to appeal to the next level, you must submit a completed grievance appeal form (Appendix C-2) to the Vice Chancellor of Human Resources within ten (10) days of receipt of this response. The grievance appeal form must be accompanied by a copy of all processed grievance forms, along with any attachments and other documents of an evidentiary nature. DISTRICT USE ONLY Date Received: APPENDIX D MOU REEMPLOYMENT PREFERENCE FOR 2020/2021, 2021/2022, 2022/2023 AND
GRIEVANCE APPEAL FORM. If the reporting structure is unclear, HR shall provide the grievant with the name of the next person in the appeal process.
GRIEVANCE APPEAL FORM. STEP 1 Delivered by Official Grievance Committee Member to Officer in Charge: Received by Date Officer in Charge Answer: Officer in Charge Signature Date APPENDIX C GRIEVANCE APPEAL FORM STEP 2 Delivered by Official Grievance Committee Member to Police Chief: Date Employee's Signature Received by Date Police Chief Answer: Police Chief Signature Date APPENDIX D CITY OF VERMILION & OHIO PATROLMEN’S BENEVOLENT ASSOCIATION GRIEVANCE APPEAL FORM Name of Employee Grievance No. Classification Date and Time Grievance Happened Location of Happening Date Presented Date Grievance First Discussed and Name of Supervisor Article(s) and Section(s) of the Agreement Violated Statements of Facts Relief Requested Official Grievance Committee Signatures EMPLOYEE'S SIGNATURE (If group grievance - signature of all employees filing grievance should be attached. Above signature shall be the employee who represents the group.) Date Received by Management
GRIEVANCE APPEAL FORM. This form shall be utilized in the event an employee disagrees with the disposition of his grievance and shall be used at any level prior to final disposition. Said forms are to be provided by the Employer.
