G.M.E.A
Name Date
E-Mail Address
Job Title Work Phone
Supervisor Dept.
Date Grievance Occurred
Specific Contract violation and any other applicable section:
Article # Section #
Grievance is: (State briefly the general nature of the complaint and the facts giving rise to it. Use reverse side of form, if needed.)
Corrective Action Requested:
Grievance Filing Date
Signature of Union Representative
Signature of Grievance Committee Member
