Get Internal Affairs - San Jose Police Department

FUPOA POLICE OFFICER UNIT GRIEVANCE FORM Allegations of a violation of the Police Officer Agreement in effect between the University and FUPOA must be filled in on this form. See your Agreement for details regarding the filing of a grievance. PLEASE PROVIDE THE INFORMATION REQUESTED IN ACCORDANCE WITH ARTICLE 6 GRIEVANCE PROCEDURE OF THE POLICE OFFICER UNIT AGREEMENT. GRIEVANT S NAME NAME OF GRIEVANT S IMMEDIATE SUPERVISOR CAMPUS DEPARTMENT/DIVISION EMPLOYEE CLASSIFICATION TITLE WORK TELEPHONE NON-WORK ADDRESS TO WHICH CORRESPONDENCE MAY BE SENT TO GRIEVANT EMPLOYEE EMPLOYMENT STATUS c Career/Regular GRIEVANT S NORMAL WORK SCHEDULE Probationary Casual/Temporary Full Time Part Time IF REPRESENTED IN THIS GRIEVANCE PROVIDE THE FOLLOWING REPRESENTATIVE S NAME TYPE OF GRIEVANCE INDIVIDUAL GROUP LIST ALL GRIEVANTS SPECIFIC ARTICLE S SECTION S OF THE CONTRACT ALLEGED TO BE VIOLATED UNION MUST BE SIGNED BY THE PRESIDENT OR DESIGNEE DATE OF ACTION CAUSING GRIEVANCE DATE OF INFORMAL DISCUSSION WITH SUPERVISOR // ALLEGED VIOLATION OF AGREEMENT REMEDY REQUESTED GRIEVANT S AND/OR REPRESENTATIVE S SIGNATURE DATE GRIEVANCE REVIEW -- STEP 1 DATE STEP 1 GRIEVANCE RECEIVED BY UC DATE OF UC RESPONSE STEP 1 DECISION SIGNATURE OF STEP 1 REVIEWER PRINTED NAME AND TITLE OF STEP 1 REVIEWER TELEPHONE NUMBER I DO NOT ACCEPT AND APPEAL THE STEP 1 RESPONSE TO THE SECOND STEP STATE SUBJECT BELOW SUBJECT OF GRIEVANCE AT STEP 2 IF DIFFERENT THAN SUBJECT OF GRIEVANCE AT STEP 1. DATE STEP 2 APPEAL POSTMARKED/HAND-DELIVERED UC DATE OF UC RESPONSE DECISION ATTACHED YES NO If no decision status. PLEASE PROVIDE THE INFORMATION REQUESTED IN ACCORDANCE WITH ARTICLE 6 GRIEVANCE PROCEDURE OF THE POLICE OFFICER UNIT AGREEMENT. GRIEVANT S NAME NAME OF GRIEVANT S IMMEDIATE SUPERVISOR CAMPUS DEPARTMENT/DIVISION EMPLOYEE CLASSIFICATION TITLE WORK TELEPHONE NON-WORK ADDRESS TO WHICH CORRESPONDENCE MAY BE SENT TO GRIEVANT EMPLOYEE EMPLOYMENT STATUS c Career/Regular GRIEVANT S NORMAL WORK SCHEDULE Probationary Casual/Temporary Full Time Part Time IF REPRESENTED IN THIS GRIEVANCE PROVIDE THE FOLLOWING REPRESENTATIVE S NAME TYPE OF GRIEVANCE INDIVIDUAL GROUP LIST ALL GRIEVANTS SPECIFIC ARTICLE S SECTION S OF THE CONTRACT ALLEGED TO BE VIOLATED UNION MUST BE SIGNED BY THE PRESIDENT OR DESIGNEE DATE OF ACTION CAUSING GRIEVANCE DATE OF INFORMAL DISCUSSION WITH SUPERVISOR // ALLEGED VIOLATION OF AGREEMENT REMEDY REQUESTED GRIEVANT S AND/OR REPRESENTATIVE S SIGNATURE DATE GRIEVANCE REVIEW -- STEP 1 DATE STEP 1 GRIEVANCE RECEIVED BY UC DATE OF UC RESPONSE STEP 1 DECISION SIGNATURE OF STEP 1 REVIEWER PRINTED NAME AND TITLE OF STEP 1 REVIEWER TELEPHONE NUMBER I DO NOT ACCEPT AND APPEAL THE STEP 1 RESPONSE TO THE SECOND STEP STATE SUBJECT BELOW SUBJECT OF GRIEVANCE AT STEP 2 IF DIFFERENT THAN SUBJECT OF GRIEVANCE AT STEP 1. GRIEVANT S NAME NAME OF GRIEVANT S IMMEDIATE SUPERVISOR CAMPUS DEPARTMENT/DIVISION EMPLOYEE CLASSIFICATION TITLE WORK TELEPHONE NON-WORK ADDRESS TO WHICH CORRESPONDENCE MAY BE SENT TO GRIEVANT EMPLOYEE EMPLOYMENT STATUS c Career/Regular GRIEVANT S NORMAL WORK SCHEDULE Probationary Casual/Temporary Full Time Part Time IF REPRESENTED IN THIS GRIEVANCE PROVIDE THE FOLLOWING REPRESENTATIVE S NAME TYPE OF GRIEVANCE INDIVIDUAL GROUP LIST ALL GRIEVANTS SPECIFIC ARTICLE S SECTION S OF THE CONTRACT ALLEGED TO BE VIOLATED UNION MUST BE SIGNED BY THE PRESIDENT OR DESIGNEE DATE OF ACTION CAUSING GRIEVANCE DATE OF INFORMAL DISCUSSION WITH SUPERVISOR // ALLEGED VIOLATION OF AGREEMENT REMEDY REQUESTED GRIEVANT S AND/OR REPRESENTATIVE S SIGNATURE DATE GRIEVANCE REVIEW -- STEP 1 DATE STEP 1 GRIEVANCE RECEIVED BY UC DATE OF UC RESPONSE STEP 1 DECISION SIGNATURE OF STEP 1 REVIEWER PRINTED NAME AND TITLE OF STEP 1 REVIEWER TELEPHONE NUMBER I DO NOT ACCEPT AND APPEAL THE STEP 1 RESPONSE TO THE SECOND STEP STATE SUBJECT BELOW SUBJECT OF GRIEVANCE AT STEP 2 IF DIFFERENT THAN SUBJECT OF GRIEVANCE AT STEP 1. DATE STEP 2 APPEAL POSTMARKED/HAND-DELIVERED UC DATE OF UC RESPONSE DECISION ATTACHED YES NO If no decision status.