Virtual Employee Statement

**GRIEVING EMPLOYEE’S STATEMENT**

Name of Aggrieved

Personal E-mail

Personal Cell Phone #

NCS/Hire Date

Bargaining Unit/Employer

Work Location

Job Title

Date of Occurrence

Approx. Time

First Level Supervisor

District Level Manager (if known)

Please state, in your own words, exactly what happened

Please state, in your own words, what remedy you are seeking to resolve this matter

By checking this box, I certify all information is true and correct to the best of my knowledge.

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