SPA/CSS EMPLOYEE GRIEVANCE AND APPEAL REQUEST FORM

EAST CAROLINA UNIVERSITY

Instructions:

To file a formal grievance, an employee is required to complete and submit this form to the Department of Human Resources in accordance with the guidelines of the University's regulations regarding Grievance and Appeal Policy for Employees Subject to the Personnel Act. All sections MUST be completed. (Attach additional sheets if necessary.)

A. EMPLOYEE INFORMATION        

Full Name: _______________________________________________________________

Position Title: ______________________    Department: __________________________

Campus Address: ___________________    Work Telephone: ______________________

Home Address: ______________________  Home Telephone: ______________________

Date of Incident: _____________________  Supervisor's Name: _____________________

B.  GRIEVANCE INFORMATION

I am requesting a Step 1 / 2 / 3 Grievance Hearing

(Circle 1, 2 or 3 to indicate which Step is requested)

C.  State the specific reason(s) for the grievance:

D.  State the specific resolution being requested:

SUBMIT THIS FORM TO: Associate Vice Chancellor of Human Resources, Department of Human Resources, East Carolina University, 210 East First Street, Greenville, NC 27858