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GRIEVANCE FORM
DISTRIBUTION
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TEAMSTERS LOCAL UNION #100
Union
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2100 Oak Rd513-769-5100Steward
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Cincinnati, OH 45241
(800) 769-5188
Managment
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Affiliated with the International Brotherhood of TeamstersEmployee
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GRIEVANCE #240601-451
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NameDate Filed
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Address
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CityStateZip
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Phone #Last 4 of Socail Security Number
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Employed bySeniority Date
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Date I saw my employer on the GrievanceArticle
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INSTRUCTIONSTO PRINT: CLICK ON PRINTER >>>>
AND PRESS CTRL+P
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**YOU MUST PRINT 4 COPIES - SIGN & TIME STAMP EACH SHEET**
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You must 'REFRESH/RELOAD' page if you need to fill out multiple forms so a new GRIEVANCE # will populate
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By presenting this form, you grant the Union complete authority to present, negotiate, and bargin regarding this
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grievance and agrees to be bound by such disposition of the grievance as may be made or agreed to by the Union or
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its delegated representatives. The undersigned employee may be present at any and all steps of the grievance process.
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GRIEVANCE: (Give Dates)
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MY CLAIM IS:
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YOUR SIGNATURE
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DISPOSITION OF GRIEVANCE (FILLED OUT BY THE BUSINESS AGENT)
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HEARING DATE
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BUSINESS AGENTCOMPANY REP
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