Revised 7-1-17
NAPE/AFSCME
and
State of Nebraska
Name of Employee (Grievant)
NOTE: Within 15 workdays of the occurrence of the grieved action (or from the day the employee should have known about the action) the employee shall present a formal written
grievance (on the grievance form) to the Agency Head (Step One).
Describe in detail, how, when, and where the portion(s) of
the Labor Contract you have identified were misapplied
and/or misinterpreted. (Use extra pages if necessary.)
Employee/Grievant Signature (REQUIRED)
Union Steward’s/Other Representative’s Signature
Steward’s City, State, ZIP
Steward’s Home Phone Number
Agency Head’s/Designee’s Signature
Agency Head/Designee Response (use extra pages, if necessary):
NOTE: If dissatisfied with the Step One response, the grievant has 15 workdays to appeal through the Administrator of the DAS Employee Relations Division (Step 2), with a copy to the
Agency Head.
Please fill out after the 1
st
step answer, if you wish to go to second step
WAIVER
Pursuant to Sections 4.7 and 4.7.8 of the current Collective Bargaining Agreement between the State of Nebraska and NAPE/AFSCME Local 61, I hereby acknowledge that I am choosing to
submit my grievance appeal through the voluntary and binding arbitration process and that the decision rendered by the arbitrator will be final and binding and will not be subject to appeal
except as provided by the Uniform Arbitration Act.
→ NOTE: Make yourself a copy of this form before turning it in to management.
