9.5 GRIEVANCE RECORD

9.5 GRIEVANCE RECORD
PLEASE FILL OUT COMPLETELY
Name *

First Name Last Name
Phone Number *
Address *

Street Address

City State / Province

Postal / Zip Code
Email *
example@example.com
Name of company *
Occupation *
Seniority Date *

Month Day Year
Date
Employee I.D. # (If applicable) *
Worksite Location / Center Name
Manager/Supervisor *
Violation of National Master UPS Agreement Article 37, section 1(c) for excessive overtime.

Please enter hours worked below, and if using a UPS timecard app, subtract any unpaid break time or lunch.
This grievance is for weekending: *

Month Day Year
Date
Hours for Monday: *
Hours for Tuesday: *
Hours for Wednesday: *
Hours for Thursday: *
Hours for Friday: *
Total estimated hours over 9.5: *
When did you join Local 222?

Month Day Year
Date
This submission is written request that the grievant be paid the triple time penalty for these hours of excessive overtime.

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 *

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Should be Empty: