Grievance Form

Communication Workers of America
Local 9431

161 Palm Avenue, Suite 1, Auburn, California 95603
Phone: 530-823-9431 Fax: 530-823-0239

(This form to be filled out by the Grievant and will be sent to the Union Steward; be sure to read the paragraph at the bottom of the page. Please write Legibly Important: Sign and date the form accordingly.)

                                   Please fill out  all Information  as it is required to process this grievance
Grievantís  name: Supervisor's name:
Job Title&Shift Occurrence date:
Home address: Work location:
City: State: Zip: Work phone:
Home phone:

E-mail address:

Statement of Grievance:
Sign______________________________________      Date_________________

By Submitting this you authorize any certified CWA representative to have copies of any of your records that may affect your condition of employment. This includes medical records or opinions, security reports or any records necessary and relevant to protect your rights under the collective bargaining agreement and any labor laws that apply.