Grievance Form
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GRIEVANCE FORM TEAMSTERS LOCAL UNION 769 8000 Orange #107 8000S.Orange AveAve - #107 Orlando, FL 32932 Orlando, FL 32932
12365W. W.Dixie DixieHwy. Hwy. 12365 Miami, FL 33161 Miami, FL 33161
862 20-Place 3400 43rd Ave. Suite 3 Vero Beach, FL 32960 Vero Beach, FL 32960
Grievant's Name ____________________________ Job Title ______________________ Complete Address _________________________________________________________ (Include Zip Code)
Shift ______________
Work Phone _________________
Home Phone _____________
Employer Manager ___________________
Employer _________________________
1
Grievant's Statement of Grievance; Describe in detail the action giving rise to the complaint. Specify names, dates, classification, place and site of violation, time,etc.
2
Specify the Article(s) of the agreement which is/are violated.
3
What is the remedy and/or relief sought?
__________________________
_______________________________________
I hereby authorize the Teamsters Local Union 769 to act for me in the disposition and settling of this grievance. Date
________________________
Date ________________________
Grievant's
Signature
Steward Signature
_________________________________________ _________________________________________
DECISION & APPEAL OF GRIEVANCE Decision of Manager
Date
of
Signature
Decision of
__________
Union
Steward
Employer's
Signature
____________________________________________
YES: _______________
Grievance Settled:
_______________________
Title
______________
Date
______________
NO: ______________
Case Appealed to: ___________________________________________
Date ______________________
Case Appealed by: ___________________________________________
Date ______________________
Decision of Appeal:
Signature Signature
of
Deciding
Union
Employer
Representative:
Officer:
_____________________________
___________________________________
Date Date
Grievance Settled:
YES: _______________
NO: _______________
Case Filed for Arbitration
YES: _______________
NO: _______________
By: ___________________________________________
_____________________ _____________________
Title: _______________________________
GRIEVANCE FORM TEAMSTERS LOCAL UNION 769 8000 Orange #107 8000S.Orange AveAve - #107 Orlando, FL 32932 Orlando, FL 32932
12365W. W.Dixie DixieHwy. Hwy. 12365 Miami, FL 33161 Miami, FL 33161
862 20-Place 3400 43rd Ave. Suite 3 Vero Beach, FL 32960 Vero Beach, FL 32960
Grievant's Name ____________________________ Job Title ______________________ Complete Address _________________________________________________________ (Include Zip Code)
Shift ______________
Work Phone _________________
Home Phone _____________
Employer Manager ___________________
Employer _________________________
1
Grievant's Statement of Grievance; Describe in detail the action giving rise to the complaint. Specify names, dates, classification, place and site of violation, time,etc.
2
Specify the Article(s) of the agreement which is/are violated.
3
What is the remedy and/or relief sought?
__________________________
_______________________________________
I hereby authorize the Teamsters Local Union 769 to act for me in the disposition and settling of this grievance. Date
________________________
Date ________________________
Grievant's
Signature
Steward Signature
_________________________________________ _________________________________________
DECISION & APPEAL OF GRIEVANCE Decision of Manager
Date
of
Signature
Decision of
__________
Union
Steward
Employer's
Signature
____________________________________________
YES: _______________
Grievance Settled:
_______________________
Title
______________
Date
______________
NO: ______________
Case Appealed to: ___________________________________________
Date ______________________
Case Appealed by: ___________________________________________
Date ______________________
Decision of Appeal:
Signature Signature
of
Deciding
Union
Employer
Representative:
Officer:
_____________________________
___________________________________
Date Date
Grievance Settled:
YES: _______________
NO: _______________
Case Filed for Arbitration
YES: _______________
NO: _______________
By: ___________________________________________
_____________________ _____________________
Title: _______________________________
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