Southwest Texas Junior College Employee Complaint Form

Southwest Texas Junior College Employee Complaint Form - Level One Page 3

SOUTHWEST TEXAS JUNIOR COLLEGE

EMPLOYEE COMPLAINT FORM – LEVEL TWO

To appeal a Level One decision or the lack of a timely response after a Level One

conference, please fill out this form completely and submit by hand delivery, fax, or U.S.

mail to the appropriate Dean within the time set out in SWTJC Policy DGBA (LOCAL).

Level Two appeals will be considered in accordance with DGBA (LEGAL) and

(LOCAL) or any exceptions outlined therein.

Name___________________________________________________________________

Address_________________________________________________________________

Telephone number ________________________________________________________

Employment Position ___________________Campus/Department __________________

Representative’s Name, if any _______________________________________________

Representative’s Address ___________________________________________________

Representative’s Phone Number______________________________________________

To whom did you present your complaint at Level One? __________________________

Date of Level One conference _______________________________________________

Date you received Level One response_________________________________________

Please explain specifically how you disagree with the outcome at Level One (use

additional pages if needed):

Attach a copy of your original complaint and any documentation submitted at Level One.

Attach a copy of the Level One response being appealed, if applicable.

Employee signature________________________________________________________

Signature of Employee’s representative, if any __________________________________

Date of filing_____________________________________________________________

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For Administrative Use Only:

Date received_______________________

Level Two Complaint form received by _______________________________________

Southwest Texas Junior College Employee Complaint Form - Level One Page 3