Employee Complaint Form Level One
To file a formal complaint, please fill out this form completely with the time established in DGBA(Local).  All complaints will be heard in accordance with DGBA(LEGAL) and (LOCAL) or any exceptions outlined therein.
Email *
Name *
Address *
Telephone Number *
Position *
Campus/Department *
If you will be represented in voicing your complaint, please identify the person representing you.
Name:
 *
Address *
Telephone Number *
Please describe the decision or circumstances causing your complaint (give specific factual details). *
What was the date of the decision or circumstances causing your complaint? *
Please explain how you have been harmed by this decision or circumstance.  *
Please describe any efforts you have made to resolve your complaint informally and the responses to your efforts. *
With whom did you communicate? *
On What Date? *
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/
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Please describe the outcome or remedy you seek for this complaint. *
Employees Name *
Employee's representative: *
Date of filing *
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/
DD
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YYYY
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