TLU767 Grievance Form

TEAMSTERS LOCAL 767 GRIEVANCE FORM

Fill out this form, print and give a copy of your grievance to your Union Steward to complete the first step in the grievance process. For assistance filling out your grievance, reach out to your Union Steward.
First and Last Name*
Last 4 digits of Social Security Number*
Phone*
Best time to call you*
Your Email Address*
example@example.com
Today's Date*

MonthDayYear
Date
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer/ Location*
Classification*
Shift*
Seniority Date*
When did you start at your company?
Current pay rate*
Nature of Grievance*

Unjust DischargeUnjust SuspensionProtest of WarningPay ClaimOther- type below or skip to next question for Pre-filled Grievances
Pre-filled options for Nature of Grievance
What type of Unjust Discharge?

Actual Discharge- you are actively being firedIntent to Discharge- you are not yet fired but you may have received an intent to discharge letter
WHEN did the violation occur? Give date(s) and time(s)*
WHERE did the violation take place?*
WHO were the people involved? Give the first and last names of all witnesses along with their phone numbers, if known. Identify all management personnel involved and indicate their title or area of responsibility.*
WHAT happened? Give a BRIEF description of the facts of your claim. Do not argue your case here. Just the facts
WHAT happened? Give a Brief description of the facts of your claim. Do not argue your case here. Just the facts.
WHAT happened? Give a Brief description of the facts of your claim. Do not argue your case here. Just the facts.
WHAT happened? Give a BRIEF description of the facts of your claim. Do not argue your case here; Just the facts please.*

The company will see this- please keep it brief.0/1190
WHAT happened? Give a BRIEF description of the facts of your claim. Do not argue your case here; Just the facts please.
Contract Articles Violated? Choose "other" option to type your own articles.
Copy of contract articles violated
Contract Articles Violated? Type other Articles here.
Contract Articles Violated?- Supervisor Working
Contract Articles Violated?- Subcontracting
Contract Articles Violated?- 9.5 Rights Violation
SETTLEMENT REQUESTED BY GRIEVANT: To be "made whole" in every way in addition to the following remedy*

0/725
SETTLEMENT REQUESTED BY GRIEVANT: To be "made whole" in every way in addition to the following remedy- Subcontracting

0/725
SETTLEMENT REQUESTED BY GRIEVANT: To be "made whole" in every way in addition to the following remedy- Supervisor working

0/725
SETTLEMENT REQUESTED BY GRIEVANT: To be "made whole" in every way in addition to the following remedy- 9.5

0/725
THIS EMPLOYEE STATEMENT IS PRIVILEGED INFORMATION FOR UNION USE ONLY.INSTRUCTIONS TO EMPLOYEE: Do not give a copy of this statement to management! Detach this page and give this statement to your Union Steward! The purpose of this statement is for you to tell why you think you have a case. Tell why you feel management has committed a violation.

This statement will appear on page 30/3700
GRIEVANT'S SIGNATURE*

By the above signature I hereby give authority to any representative of the Union to represent me in this matter in the event I am not present at any subsequent hearing on this grievance. Clear
Should be Empty:

TEAMSTERS LOCAL 767 GRIEVANCE FORM