Request for Arbitration Panel
Please submit one request per grievance. Once the form has been submitted, you will receive an e-mail response with a copy of all data submitted.
If you have any questions while completing the form, contact the Bureau at 651-649-5421.
Request Type:
*
Public Grievance
Private Grievance
Hospital Grievance
Teacher's Discharge
Peace Officer Discipline Grievance
Veteran's Preference
Minn. Stat. 43A
Independent Review
Name of Employer:
*
Full Name of Employer
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Employer Representative or Counsel:
*
First Name
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
Please enter a valid phone number.
Email:
*
example@example.com
Name of Union:
*
Full Name of Union or Organization
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Union Representative or Counsel
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
Please enter a valid phone number.
Email:
*
example@example.com
Employer Type:
*
Please Select
Private Employer
Board/Commission
City
County
EMS - Other than City or Hospital
Fire District - Other than City
Higher Education
Hospital
Joint Powers
Municipal Utility
School District
State
University
Other Public
Do not include name of Grievant if discipline related.
Concise Statement of Grievance:
*
Example: "Suspension Grievance"
Date of Request:
*
-
Month
-
Day
Year
Date
Name of Person Filing this Request:
*
First Name
Last Name
Email:
*
example@example.com
Signature
*
Submit
Should be Empty: