FILE: GAEA-E1
GRIEVANCE INITIATION
INSTRUCTIONS: Complete four copies of this form. Give the original to your immediate supervisor. Send one copy to the Superintendent, one copy to Personnel and retain one copy for your records. If you have any questions, see your supervisor.
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Employee's Name Home Address Title
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Department (School) Division Location
1. Give complete Statement of Grievance (be very specific):
2. Give recommendation about what should be done about it:
3. Has this grievance been discussed with your immediate supervisor?
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Name of Supervisor Title
4. What other person, besides yourself, do you want notified of any hearings or actions taken on this grievance?
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Name Mailing Address
His/her role in this grievance:
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Employee's Signature Date
________________
Form #
Distribution:
Original - Supervisor
Copy - Employee
Washington Parish School Board