Southwest Texas Junior College Employee Complaint Form

SOUTHWEST TEXAS JUNIOR COLLEGE

EMPLOYEE COMPLAINT FORM – LEVEL THREE

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

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

mail to the President within the time set out in SWTJC Policy DGBA (LOCAL). Level

Three appeals will be considered in accordance with DGBA (LEGAL) and (LOCAL) or

any exceptions outlined therein. The President will appoint a Level Three Committee

which will hear the Level Three complaint.

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 Two? __________________________

Date of Level Two conference _______________________________________________

Date you received Level Two response ________________________________________

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

additional pages if needed):

Attach a copy of your original complaint and any documentation previously submitted.

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

Employee signature________________________________________________________

Signature of Employee’s representative, if any __________________________________

Date of filing of Level Three Complaint _______________________________________

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For Administrative Use Only:

Date received________________

Level Three Complaint form received by_______________________________________

Southwest Texas Junior College Employee Complaint Form - Level One Page 4