COMMUNICATIONS WORKERS OF AMERICA LOCAL 9588
| 190 West "G" STREET * COLTON, CA 92324 |
(909)422-8960 (Office) |
Member's Statement of Facts
| Member's Name: | Date: | |
| Member's Seniority Date: | SSN: | |
| Home Address: | City: | Zip: |
| Home Phone: | Work Phone: | |
| Dept/Location: | RC: | |
| Union person contacted: | Date: | |
| If for workgroup, names of
individuals in the workgroup:
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| 1st Line Supervisor | 2nd Line Supervisor |
| Grievance against whom: | Date of occurrence: |
Please write in your own words and to the best of your knowledge all the facts, names, dates and circumstances leading up to this grievance (use back of form if more space is needed). Please sign the form and return to your representative or mail to the address indicated.
Statement:
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Signature:__________________________________________________________________
RETURN TO YOUR STEWARD OR MAIL TO CWA LOCAL 9588, 190 WEST
"G" STREET, COLTON, CA 92324
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***FOR LOCAL USE ONLY***
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