District 9 - Grievance Statement
Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
EIN Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
*
-
Area Code
Phone Number
Location/Station/Branch/MPO and Pay Location
*
Seniority Date
N/S Days
*
(FTR) (PTR) (PTF) (PSE)
Life Time Security (Y) (N)
*
Veteran(Y) (N)
*
DO YOU WANT TO BE PRESENT AT STEP 1 MEETING (Y) (N)
*
DETAIL STATEMENT
*
File Upload
Browse Files
Cancel
of
Employee Signature & Date
*
Supervison/Manager
First Name
Last Name
Save
Submit
Should be Empty: