A | B | C | D | E | F | G | H | |
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1 | GRIEVANCE FORM | DISTRIBUTION | ||||||
2 | TEAMSTERS LOCAL UNION #100 | Union | ||||||
3 | 2100 Oak Rd | 513-769-5100 | Steward | |||||
4 | Cincinnati, OH 45241 | (800) 769-5188 | Managment | |||||
5 | Affiliated with the International Brotherhood of Teamsters | Employee | ||||||
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7 | GRIEVANCE # | 240601-451 | ||||||
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10 | Name | Date Filed | ||||||
11 | Address | |||||||
12 | City | State | Zip | |||||
13 | Phone # | Last 4 of Socail Security Number | ||||||
14 | Employed by | Seniority Date | ||||||
15 | Date I saw my employer on the Grievance | Article | ||||||
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18 | INSTRUCTIONS | TO PRINT: CLICK ON PRINTER >>>> | AND PRESS CTRL+P | |||||
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20 | **YOU MUST PRINT 4 COPIES - SIGN & TIME STAMP EACH SHEET** | |||||||
21 | You must 'REFRESH/RELOAD' page if you need to fill out multiple forms so a new GRIEVANCE # will populate | |||||||
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23 | By presenting this form, you grant the Union complete authority to present, negotiate, and bargin regarding this | |||||||
24 | grievance and agrees to be bound by such disposition of the grievance as may be made or agreed to by the Union or | |||||||
25 | its delegated representatives. The undersigned employee may be present at any and all steps of the grievance process. | |||||||
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27 | GRIEVANCE: (Give Dates) | |||||||
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34 | MY CLAIM IS: | |||||||
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40 | YOUR SIGNATURE | |||||||
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42 | DISPOSITION OF GRIEVANCE (FILLED OUT BY THE BUSINESS AGENT) | |||||||
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44 | HEARING DATE | |||||||
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47 | BUSINESS AGENT | COMPANY REP | ||||||
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