9.5 GRIEVANCE RECORD

9.5 GRIEVANCE RECORD
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Name*

First NameLast Name
Phone Number*
Address*

Street Address

CityState / Province

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

MonthDayYear
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:*

MonthDayYear
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?

MonthDayYear
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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