APPENDIX C
CONTRA COSTA COMMUNITY COLLEGE DISTRICT
STATEMENT OF GRIEVANCE
| EMPLOYEE NAME
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COLLEGE | DEPARTMENT |
| DATE OF ALLEGED GRIEVANCE
|
DATE OF INFORMAL DISCUSSION WITH DEAN OR DESIGNEE | DATE OF ORAL RESPONSE |
| DATE OF FILING OF THIS STATEMENT
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INVOLVED MANAGER(S) AND SPECIFIC ARTICLES AND SECTIONS ALLEGED TO HAVE BEEN VIOLATED
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| EMPLOYEE’S STATEMENT OF ALLEGED VIOLATION AND GRIEVANCE. WHAT IS THE FACTUAL CONTENTION, WHAT HAS OCCURRED? PROVIDE FULL FACTS NECESSARY TO SUPPORT YOUR POSITION.
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| STATE FULL RELIEF, REMEDY, ACTION, YOU BELIEVE IS REQUIRED TO RESOLVE THIS ALLEGED GRIEVANCE:
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| I. COLLEGE PRESIDENT OR DESIGNEE, RESPONSE TO ALLEGED GRIEVANCE:
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DATE OF RECEIPT:
DATE OF RESPONSE: |
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| GRIEVANCE RESOLVED:
GRIEVANCED DENIED: |
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| DATE OF GRIEVANT APPEAL:
GRIEVANT SIGNATURE: |
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| II. CHANCELLOR/DESIGNEE, RESPONSE TO ALLEGED GRIEVANCE:
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DATE OF RECEIPT:
DATE OF RESPONSE: |
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| GRIEVANCE RESOLVED:
GRIEVANCE DENIED: |
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| DATE OF GRIEVANT APPEAL:
GRIEVANT SIGNATURE: |
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| WRITTEN NOTICE OF APPEAL TO A “FACT-FINDING PANEL” MUST BE FURNISHED WITHIN FIFTEEN (15) WORK DAYS TO THE CHANCELLOR. DATE OF UNITED FACULTY NOTICE: __________________________________________
(OPTIONAL) |
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THE DECISION OF THE PANIS IS: (IF APPLICABLE) |
DATE OF HEARING:
DATE OF RESPONSE:
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THE DECISION OF THE BOARD IS: (IF APPLICABLE) |
DATE OF RECEIPT:
DATE OF BOARD MEETING:
DATE OF DECISION: |
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