Grievance Form
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1
2GRIEVANCE FORM
Teamsters Local Union No. 769
8000 S. Orange Ave. Suite 107
3400 43rd Ave. Suite 3
12365 West Dixie Hwy.
Orlando, Florida 32809
Vero Beach, Florida 32960-1808
North Miami, Florida 33161-5428
Grievant’s’ Name: ____________________________________Job Title: ____________________________
Complete Address: _______________________________________________________________________
Shift: _____________ Work Phone: _____________________ Home Phone: _________________________
Cell Phone: _____________________________ Email Address: __________________________________
___________________________
Employer: _________________Employer Supervisor/Manager:
_________________________________
1.
Grievant’s Statement of Grievance:
(Describe in detail the action giving rise to the complaint. Specify names, dates,
classification, place and site of violation, time, etc....)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2.
Specify the Article(s) of the Agreement which is/are violated:
____________________________________________,and any other pertinent Articles
3.
What is the remedy and/or relief sought?
________________________________________________________________________
________________________________________________________________________
I hereby authorize the Teamsters Local Union No. 769 to act for me in the disposition and settling of this grievance.
Date: _____________________ Grievant’s Signature: ___________________________________
Date: _____________________ Steward Signature: ____________________________________
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