Faculty & Staff Formal Grievance Form
General Information
Employee’s Name: ________________________________ Department: _________________________
Job Title: ________________________________________ Date of event or condition: _____________
Date discussed with immediate supervisor: ______________________
Formal Grievance [Employee should keep one copy and give one to his/her immediate supervisor.]
Specific statement of grievance. Incidents and/or facts supporting claim of grievance. (Attach additional sheets if
necessary.)
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Requested solution or remedy.
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Particular area of disagreement with decision of immediate supervisor.
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Employee’s signature _____________________________________ Date ________________________
Approved by the Sandhills Community College Board of Trustees on August 6, 2007
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