Name of Aggrieved Employee: __________________________________________________________________________
Classification: _ ________________________ Department: _ _______________________________________________
Current Address: ___________________________________________________________________________________
BOWIE STATE UNIVERSITY
University System of Maryland
Employee
What is your complaint?
____________________________________________________________________________________________
What do you think should be done?
____________________________________________________________________________________________
Who, if anyone, do you name as your representative?: ____________________________________________________
Signature: ______________________________________________________ Date: _______________________
Department Head
STEP ONE
Date form grievance was received by Department Head or designee: ___________________________________________
Deposition
____________________________________________________________________________________________
Signature: ______________________________________________________ Date: _______________________
Employee
I wish to appeal the results of Step One of the grievance procedure.
Signature: ______________________________________________________ Date: _______________________
Form for Formal
Request, Problem,
Complaint, or Grievance
President/Chancellor
or Designee
STEP TWO
Date appeal from Step One form was received by President/Chancellor or designee:
Date of Hearing: ________________________________________________________________________________
Hearing Ocer: ________________________________________________________________________________
Disposition (attach a copy of the disposition)
Signature: ______________________________________________________ Date: _______________________
Employee
I wish to appeal the results of Step Two of the grievance procedure to the Oce of Administrative Hearing or Arbitration.
Signature: ______________________________________________________ Date: _______________________
Hearing Ocer
STEP THREE
Date appeal was received by Oce of Administrative Hearing _______________________________________________
Hearing Ocer: ________________________________________________________________________________
Disposition (attach a copy of the disposition)
Signature: ______________________________________________________ Date: _______________________
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