STATEMENT BY GRIEVANT OR UNION. The "statement" should include: (1) nature of the contract violation; i.e., what action did the employer take, or fail to take, which violated the Contract; (2) the date(s) of the violation and, where appropriate as in promotions, demotions, transfers, reassignments, etc., the relevant title(s) and work location(s). (Use additional sheets of paper, if necessary.) RELIEF OR REMEDY SOUGHT Grievant's Signature Date Xxxxxxx/Union Representative Signature Date In accordance with Articles 22 and 23, all disciplinary grievances must also include the following completed form. WAIVER OF RIGHT TO APPEAL DISCIPLINARY ACTION I wish to submit the attached grievance under Article 23, Grievance Procedure and Article 22, Arbitration of Disciplinary Action, appealing my demotion, suspension or discharge effective on and pursuant to Article 22, Section 4 of the Agreement between the NAGE and the Commonwealth of Massachusetts dated I hereby waive any and all rights to appeal this disciplinary action to any other forum including the Civil Service Commission. I have not initiated any other appeal of this disciplinary action. DATE EMPLOYEE SIGNATURE UNION REPRESENTATIVE SIGNATURE APPENDIX C NON-SELECTION FORM EMPLOYEE NAME CURRENT POSITION X.X. ADDRESS TITLE POSITION SOUGHT X.X.
STATEMENT BY GRIEVANT OR UNION. The "statement" should include: (1) nature of the contract violation; i.e., what action did the employer take, or fail to take, which violated the Contract; (2) the date(s) of the violation and, where appropriate as in promotions, demotions, transfers, reassignments, etc., the relevant title(s) and work location(s). (Use additional sheets of paper, if necessary.) RELIEF OR REMEDY SOUGHT Grievant's Signature Date Xxxxxxx/Union Representative Signature Date In accordance with Articles 22 and 23, all disciplinary grievances must also include the following completed form. WAIVER OF RIGHT TO APPEAL DISCIPLINARY ACTION I wish to submit the attached grievance under Article 23, Grievance Procedure and Article 22, Arbitration of Disciplinary Action, appealing my demotion, suspension or discharge effective on and pursuant to Article 22, Section 4 of the Agreement between the NAGE and the Commonwealth of Massachusetts dated I hereby waive any and all rights to appeal this disciplinary action to any other forum including the Civil Service Commission. I have not initiated any other appeal of this disciplinary action. DATE EMPLOYEE SIGNATURE UNION REPRESENTATIVE SIGNATURE APPENDIX C NON-SELECTION FORM EMPLOYEE NAME CURRENT POSITION X.X. ADDRESS TITLE POSITION SOUGHT X.X. TITLE Employee Identification Number: We regret to inform you that another applicant has been selected for the position you sought. That applicant has been selected (because he/she has been deemed to be more qualified than you by virtue of) for one or more of the following reasons:
STATEMENT BY GRIEVANT OR UNION. The "statement" should include: (1) nature of the contract violation; i.e., what action did the employer take, or fail to take, which violated the Contract; (2) the date(s) of the violation and, where appropriate as in promotions, demotions, transfers, reassignments, etc., the relevant title(s) and work location(s). (Use additional sheets of paper, if necessary.) RELIEF OR REMEDY SOUGHT Xxxxxxxx's Signature Date Xxxxxxx/Union Representative Signature Date In accordance with Articles 22 and 23, all disciplinary grievances must also include the following completed form.
STATEMENT BY GRIEVANT OR UNION. The "statement" should include: (1) nature of the contract violation; i.e., what action did the employer take, or fail to take, which violated the Contract; (2) the date(s) of the violation and, where appropriate as in promotions, demotions, transfers, reassignments, etc., the relevant title(s) and work location(s). (Use additional sheets of paper, if necessary.) ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ RELIEF OR REMEDY SOUGHT __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _____________________ ________ ______________________________________ ______ Grievant's Signature Date Xxxxxxx/Union Representative Signature Date In accordance with Articles __ and __, all disciplinary grievances must also include the following completed form. WAIVER OF RIGHT TO APPEAL DISCIPLINARY ACTION I wish to submit the attached grievance under Article 23A, Grievance Procedure and Article 23, Arbitration of Disciplinary Action, appealing my demotion, suspension or discharge effective on __________________________ and pursuant to Article 23, Section 4 of the Agreement between Local S28 and the Commonwealth of Massachusetts dated _________________________ I hereby waive any and all rights to appeal this disciplinary action to any other forum including the Civil Service Commission. I have not initiated any other appeal of this disciplinary action. _______________________________ ____________________________________ DATE EMPLOYEE SIGNATURE UNION REPRESENTATIVE SIGNATURE AppA APPENDIX D MEMORANDUM OF UNDERSTANDING BETWEEN THE COMMONWEALTH OF MASSACHUSETTS AND THE UNION, LOCAL S-28 OF THE IAFF The Parties agree that the employees covered by this Collective Bargaining Agreement will be permitted to participate in the Employer's Adoption Assistance Program. MEMORANDUM OF AGREEMENT BETWEEN THE COMMONWEALTH OF MASSACHUSETTS AND THE THE UNION, LOCAL S-28 OF THE IAFF Uniforms and Appearance This Memorandum of Understanding is entered into by the Commonwealt...
STATEMENT BY GRIEVANT OR UNION. The '"statement" should include: (1) nature of the contract violation; i.e., what action did the Employer take, or fail to take, which violated the Contract; (2) the date(s) of the violation and, where appropriate as in promotions, demotions, transfers, reassignments, etc., the relevant title(s) and work location(s). (Use additional sheets of paper, if necessary.) RELIEF OR REMEDY SOUGHT Grievant’s Signature Date Xxxxxxx/Union Representative Date Signature In accordance with Articles 23 and 23A, all disciplinary grievances must also include the following completed form. APPENDIX G-1 REQUEST FOR MEDICAL VERIFICATION FORM AGENCY LETTERHEAD Date: Dear : Pursuant to the provisions of Article 8 of the Agreement, it is requested that you submit satisfactory medical evidence for your recent time away from work on the following dates (list dates) . Medical verification is being requested because (list reasons) . Failure to produce such medical evidence by (date) may result in denial of sick leave compensation for the following dates: In order to be considered satisfactory, the medical verification must include: the date you were personally examined by your physician, physician assistant, nurse practitioner, chiropractor or dentist; the nature of your illness or incapacity (confidential illness or injury requires completion of the confidential illness certification found on the back of this notice); a statement that you were incapacitated from work due to illness or injury on the day(s) for which verification is requested; the estimated date of your return to work; and the original signature of the health care professional who examined you on his/her letterhead containing his/her address and phone number. Please be reminded that failure to submit this medical verification may result in denial of sick leave compensation. If you have any questions, please contact me. Sincerely, Signature of Supervisor/Manager cc: Personnel File The information requested on this document must be provided on the letterhead of the attending Medical Provider CONFIDENTIAL ILLNESS CERTIFICATION I, (Medical Provider) , as the medical provider for (Employee) , have reviewed his/her position description (Form 30) and certify that he/she was (circle one) unable / able to perform his/her duties on (Dates) because he/she was incapacitated by personal illness or injury. After reviewing the attached Form 30, the above referenced employee was unable to perform (specify the duty or duties that the e...
STATEMENT BY GRIEVANT OR UNION. The '"statement" should include: (1) nature of the contract violation; i.e., what action did the employer take, or fail to take, which violated the Contract; (2) the date(s) of the violation and, where appropriate as in promotions, demotions, transfers, reassignments, etc., the relevant title(s) and work location(s). (Use additional sheets of paper, if necessary.) RELIEF OR REMEDY SOUGHT Grievant's Signature Date Xxxxxxx/Union Representative Signature Date In accordance with Articles 22 and 23, all disciplinary grievances must also include the following completed form. EMPLOYEE SIGNATURE UNION REPRESENTATIVE SIGNATURE DATE WAIVER OF RIGHT TO APPEAL DISCIPLINARY ACTION I wish to submit the attached grievance under Article 23, Grievance Procedure and Article 22, Arbitration of Disciplinary Action, appealing my demotion, suspension or discharge effective on and pursuant to Article 22, Section 4 of the Agreement between the NAGE and the Commonwealth of Massachusetts dated I hereby waive any and all rights to appeal this disciplinary action to any other forum including the Civil Service Commission. I have not initiated any other appeal of this disciplinary action. APPENDIX C NON-SELECTION FORM EMPLOYEE NAME CURRENT POSITION X.X. ADDRESS TITLE POSITION SOUGHT X.X.
