Grievance Information Sheet : Union Representative James Cole
Identification and Contact Information
Page 1 of 4
Your Legal Name
*
First Name
Last Name
Alias, preferred name, or "nickname"
*
I do not have an alias, preferred name, or "nickname"
I have an alias, preferred name, or "nickname" : Please state any other names in the field attached to this question.
Your Gender or Gender Identity
*
Male
Female
Prefer not to answer
I prefer to fill in my answer:
Your Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
*
example@example.com
Your Current Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is there an alternate individual who may be an additional point of contact if we are unable to reach you?
*
Yes
No
If Yes - What is their name?
First Name
Last Name
What is their contact number?
Please enter a valid phone number.
Format: (000) 000-0000.
Are you in need of any language assistance or translation?
*
No
Yes - I need language assistance for: (please state for which language: e.g. spanish, arabic, creole, etc.)
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Grievance Information Sheet
Worker and Employment Information Section
Page 2 of 4
Your Company Hire Date
*
-
Month
-
Day
Year
Your recent hire date.
Your "PERNR" or Employee Identification Number
*
I am:
*
Full Time
Part Time
Who is your proprietor/area manager?
*
If you are not sure, please type "I do not know".
What Park, Resort, or "Other Guest Location" are you statused?
*
Example: Magic Kingdom, Epcot, Caribbean Beach Resort, Disney Springs, ESPN
What "Location" do you work at inside the Park/Resort/Other Guest Area?
*
Example: Chef Mickey's, Oga's Cantina, Jock Lindsey's Hanger Bar,
What is your job?
*
Please Select
Bartender
Cocktail Server
Coordinator (statused)
Host (seater)
Server Assistant
Server
*Other Role
If you selected "other role" as your job - please fill out the field below:
If your job was already listed in the drop-down list - ignore this field.
Are you enrolled as a union member?
*
Yes
No
Other: E.g. "I do not know" or "I need help verifying" please describe:
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Grievance Information Sheet
Incident [and or] Allegations Information Section
Page 3 of 4
What disciplinary action did you receive?
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I received a 1-Point Reprimand.
I received a 2-Point Reprimand.
I was Terminated.
I received multiple forms of disciplinary action:
Date you received disciplinary action or were terminated:
*
-
Month
-
Day
Year
If you have not received any discipline; please put the current date of today in this field.
If you have received a reprimand - please submit a photo of your copy in this field:
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It is okay if you do not have a copy of your reprimand. It is helpful if you do.
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Was a manager or chef a witness [and or] involved in the incident?
*
No
Yes:
Was a co-worker (not a manager or chef) a witness [and or] involved in the incident?
*
No
Yes:
In your own words, write a brief description of what you understand as the accusations against you? What happened?
*
Example: I was accused of harassment, I was accused of making a mistake in the allergy process.
When you were pulled in for discipline or termination, who were the managers/chefs in the room with you?
*
When you were pulled into the office (or other area) who issued the discipline? What happened during the meeting when you were disciplined?
*
Were you offered a Shop Steward when you were pulled into the office (or other area) for discipline or termination?
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I was offered a shop steward
I was not offered a shop steward
If you were offered a shop steward - who was your shop steward? If you were not offered a shop steward and one was not present please type "NA" in the field below:
*
Please use their full name if you know it.
If you have any further information you would like to include or provide - please use the field below:
Other or Miscellaneous Files - If you have any further files to submit such as witness statements - please utilize this field:
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Grievance Information Sheet
Confirmation Page
Page 4 of 4
PERSONAL DISCLAIMER: I have reviewed and completed this form to the best of my ability. The information I have recorded in this form is true and accurate to the best of my knowledge and understanding. I have reviewed and confirm the information I am about to submit.
*
I acknowledge and agree with the above personal disclaimer
Your Signature
*
Submit
Should be Empty: