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UNDER CONSTRUCTION
INTERNAL
GRIEVANCE INVESTIGATION FORM PART
"A"
XXX-00-XXXXX CONFIDENTIAL To be completed by the grievor ____________________________________________________________________________________________ Last
Name: Xxxxxxxxxxx
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Classification: XXXX
Shift: X Given
Names: Xxxxxxxxxxx
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Section/Station: Xxxxxxxxxxxxx Address:
Xxxxxxxxxxx
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Post Office: Xxxxxxxxxxx City:
Xxxxxxxxxxx
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Telephone:(______) _________all________ Postal
Code: Xxxxxxxxxxx
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Time of Shift: From:________To:___________ Telephone/FAX:
(xxx) xxx-xxxx Cell: (xxx)
xxx-xxxx
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Local: Xxxxxxxxxxxxxxx H.R.I.D.
/ S.I.N.: Xxxxxxxxxxx
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Employee: Full Time: yes Part Time: no Membership
No.:
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Casual: no Probation:
no ___________________________________________________________________________________________ Name
of Shop Steward: Xxxxxxxxxxxxxxxx
Date of Investigation: Xxxxxxxx ___________________________________________________________________________________________ PART
"B" (To be completed by the grievor or the witness(es) with the help
of the Shop Steward). Grievor:
Xxxxxxxxxxxxxxxxxxxxxxxxxxx____________________________________ The
incident giving rise to the grievance occurred on: Date: xxxxxx/98
Time: xx:xx
Location: Xxxxxxxx. Persons
involved: Supervisor: Xxxxxxxx
Witness:_ Xxxxxxxx _
Supervisor:
Witness:_ _ ____________________________________________________________________________________________ In your own words, state all
the facts On
what date did you become aware, for the first time, that you had a grievance?_xxxxx/98_ I
hereby authorize the representative(s) of the CUPW to examine my personal file. (Signature):___________________xxxxxxxx________________Date signed__xxxxxxxx_
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