Fillable EMPLOYEE GRIEVANCE FORM (City of Stephenville)

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EMPLOYEE GRIEVANCE FORM (City of Stephenville)

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The EMPLOYEE GRIEVANCE FORM (City of Stephenville) form is 4 pages long and contains:

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  • 4 check-boxes
  • 53 other fields

Country of origin: US
File type: PDF

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EMPLOYEE GRIEVANCE FORM
Grievant Name: Date:
Title: Department:
HISTORY AND FACTS OF GRIEVANCE:
Provide as much specific information as possible, including all pertinent names, dates, and places. Indicate
specifically which section of the Personnel Policies you believe was violated (if applicable). Attach additional
sheets if necessary.
REMEDY SOUGHT:
State specifically what action(s) you are requesting to resolve the complaint.
Grievant Signature Date Signed
APPENDIX E
Form 18
EMPLOYEE GRIEVANCE
Page 220 of 254
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IMMEDIATE SUPERVISOR RESPONSE
Grievance response must be returned to the aggrieved employee within ten (10) working days or receipt.
Attach additional sheets and documentation if necessary.
Supervisor’s Signature Date of Signature
GRIEVANT’S ANSWER TO SUPERVISOR RESPONSE:
I accept the resolution to Step I: YES NO
If answer is no, grievance must be submitted to Step II within five (5) working days of receipt of Step I
response. Give specific reasons why the Step I response is unsatisfactory, and what further action(s) you are
requesting to resolve the complaint.
Grievant Signature Date Signed
Appendix E
Form 18
STEP I
Page 221 of 254
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signature
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DEPARTMENT DIRECTOR RESPONSE (if Required):
The Department Director may schedule a meeting with the employee or provide a written response. The
written response shall be provided to the employee within ten (10) working days of receiving the grievance
request.
Department Director Signature Date
GRIEVANT’S ANSWER TO SUPERVISOR RESPONSE (if required):
I accept the resolution toStep II: YES NO
If answer is no, grievance must be submitted to Step III within five (5) working days of receipt of Step II
response. Give specific reasons why the Step II response is unsatisfactory, and what further action(s) you are
requesting to resolve the complaint.
Grievant Signature Date
Appendix E
Form 18
STEP II
Page 222 of 254
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signature
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CITY ADMINISTRATOR RESPONSE (if required):
At a mutually agreeable time, the City Administrator may elect to have a meeting with the employee
informally or to convene a hearing. Once the meeting or hearing has been held, the City Administrator shall
respond to the grievance within ten (10) days. As per the Policy 7.03 Grievance, the decision of the City
Administrator is final and is not eligible for further appeal.
City Administrator Signature Date
APPENDIX E
FORM 18
STEP III
Page 223 of 254
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signature
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EMPLOYEE GRIEVANCE FORM (City of Stephenville)

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Completed 3 March 2021

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