o:OHR/forms/Grievance Form 10/11/2007
The University of West Florida
University Work Force
Statement of Grievance
_________________________ ____________________ ___ _________________________
Last Name First Name MI Maiden Name
___________________________ _____________________________ ___________________
Department Position Title Position Number
______________________________________ _____________________________________
Immediate Supervisor Department Head
Expression of Grievance: (Attach additional pages as needed)
Employee’s Proposed Solution: (Attach additional pages as needed)
Employee’s Signature:
Date:
FOR OFFICE USE ONLY
Date filed at this step: Date of Response:
Respondent Signature:
Date:
Print Form