Douglas County School District

A.T.U. Grievance Form

Grievance Number: ________ Level: ________

Aggrieved Person: ________________________________ Date of Filing: ________________

Terminal Location: _______________________________ Supervisor: ___________________

Please describe, in your words, your grievance:

What provision do you believe has been violated in the A.T.U. Contract, or School Board Policy?

Have you attempted to resolve this grievance through the informal process with your supervisor? Yes _____ No _____. If “”Yes,” what was the outcome? If “No,” why not?

What do you feel would be a fair remedy for this situation?

Do you wish to waive your right to A.T.U. representation? Yes _____ No _____

____________________________________ _____________________________________
Signature Date Supervisor Date

For Administrative Use:
Outcome

_____________________________________ ____________________________________
Signature Date Position

If Grievance reaches Level II, submit copies of this form to the Director of Transportation and A.T.U.

______The ATU Grievance Committee believes this grievance violates the ATU Contract.
______The ATU Grievance Committee does not believe this grievance violates the ATU Contract.

_________________________________ ______________________________
ATU President’s Signature Date

Revised 1-2009