Grievance – CSEA Local 449

Grievance

Your Name *

First

Middle

Last

Your Title *

Your Seniority Date *

Your Shift & Pass Days *

Your Address *

Address Line 1

Address Line 2

City

State

Zip Code

Your Phone Number *

Your CSEA Number

Your Email *

Your Work Location *

Your Department or Agency *

Your Supervisor *

Complaint Information

Incident Date *

Date

Time

Describe What Happened *

Who Was Involved - Names & Titles *

Remedy Sought *

Additional Comments