9.5 GRIEVANCE RECORD

9.5 GRIEVANCE RECORD
PLEASE FILL OUT COMPLETELY
Name *

First Name Last Name
Phone Number *

Area Code 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/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: *
Requesting the grievant be paid the triple time penalty for these hours of excessive overtime.

0/100
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 *

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Should be Empty: