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Employee Grievance Form
Employee Grievance Form
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Employee Name:
Supervisor:
Please indicate the type of grievance you are filing:
*
Alleged Wrongful Disciplinary Action
Alleged Illegal Discrimination by Supervisor/Employer
Alleged Unlawful Workplace Harassment by Supervisor
Please describe the alleged problem, incident, or behavior (who, what, when, where):
*
Please describe why you believe the action was wrongful, illegal, or Unlawful:
*
If you chose, please provide the names of any employees who may have been witness to the event or events that led to the filing of this grievance.
Upon submission, you will be asked to sign and date it, and will be provided with a copy of the Employee Grievance Policy to assist you in this process. You will receive a written response to your grievance within seven days of submission.
Signature
*
Clear Signature
Date / Time of Submission
*
Date
Time
Submit
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