CWA LOCAL 7050 GRIEVANCE FORM

Local Grievance Number

NLRB Case Number

Company Grievance Number

Grievant Name SS# NCS Date

Home Address
Phone #

Work Address
Work #

Job Title Company Department
Business Unit

Wage Level
Rate of Pay

Steward taking complaint                                                                          Date received

Steward                                                                    Chief Steward

Date incident occurred
Date company notified of grievance


Complaint



Grievance Classification (must be off the grievance classification list)



Article violation and all applicable provisions of the contract



What past practices apply



What settlement is expected



Company answer at 1^st step



Company answer at 2^nd step



Disposition at Local level



Grievance meeting minutes, documentation, copies of appeal letters and rationale for appealing to the third step are attached.

Local President                                                                           Date

CWA LOCAL 7050 GRIEVANCE FORM page 2

Grievant Statement

What settlement would you like to see?

(use additional pages as necessary)

Signature of grievant                                                                             Date

CWA LOCAL 7050 GRIEVANCE FORM page 3
RELEASE OF PERSONNEL, CORPORATE SECURITY AND/OR

FMLA/MEDICAL RECORDS

I,, the undersigned, do hereby grant permission for all Union Representatives involved to examine, review and obtain copies, when necessary, of any and all portion of my personnel and/or FMLA/medical records maintained by the company, which are necessary to process a grievance in my behalf.

I understand all information and discussions of a personal nature pertaining to these records or copies of same will be held in strict confidence unless otherwise stated by me.

Signed_____________________________________ Date_________________________

Close Window

	Local Grievance Number
	NLRB Case Number
	Company Grievance Number