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Complaint Form
Local 617/ Laundry, Distribution and Food service Joint Board, Workers United, SEIU
First Name
Last Name
Home Address
City
Zip
Phone Number *
Email
Employer *
Union Representative *
Date of Incident
MM
/
DD
/
YYYY
Name of Witness (es)
Type of Incident
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Briefly Explain the Problem
Acknowledgement *
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