Employee Complaint Form - Level One
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7EMPLOYEE COMPLAINT FORM — LEVEL ONE
To file a formal complaint, please fill out this form completely and submit it by hand delivery, fax,
or U.S. mail to the appropriate administrator within 10 business days. All complaints will be
heard in accordance with board policy.
1.
Name
2.
Address
Telephone number (_____)
3.
Position
Campus/Department
4.
If you will be represented in voicing your complaint, please identify the person representing
you.
Name
Address
Telephone number (_____)
5.
Please describe the decision or circumstances causing your complaint (give specific
factual details).
6.
What was the date of the decision or circumstances causing your complaint?
7.
Please explain how you have been harmed by this decision or circumstance.
_______________________________________________________________________
Legal Policy 600.200; Board Policy 600.200; Legal Policy 300.120; Board Policy 300.120
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