Grievance Form Fill-In

Grievance Form Fill-in
PLEASE FILL OUT COMPLETELY
Name *

First Name Last Name
Phone Number *
Please enter a valid phone number.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Name of company against whom you are filing complaint: *
Occupation *
Seniority Date *

Month Day Year
Date
Employee I.D.# (If applicable) *
Worksite Location/Facility Name Center Name if U.P.S. *
Manager/Supervisor *
Give details of complaint. Be sure to include date violation occurred. *

0/105
When did you join Local 222?

Month Day Year
Date
This will constitute Teamsters Local 222 or any employee or agent designated by them as my attorney-in-fact empowered to receive on my behalf any monies due me.
Grievant's Signature

Clear
Should be Empty:

Grievance Form Fill-in