Appendix C

APPENDIX C

GRIEVANCE FORM

I. Date received by the Office of Human Resource Services (as authenticated by receipt, postmark, or date recorded on fax, as applicable) _______________________ (must be received within 60 days of the date of the act or omission giving rise to the grievance, or within 15 days of the Notice of Discipline in grievances involving disciplinary action) by:

Personal delivery _____

U. S. Mail _____

Fax _____

GRIEVANT STEP 1 GRIEVANCE REPRESENTATIVE

NAME: _______________________ NAME: ________________________

(print) (print)

CAMPUS MAILING ADDRESSES:

COLLEGE: ____________________ COLLEGE: _____________________

DEPT: ________________________ DEPT: _________________________

DEPT ADDRESS: ______________ DEPT ADDRESS: _______________

______________________________ ______________________________

PHONE: ______________________ PHONE: _______________________

If grievant is represented by the UFF or legal counsel, all University communications should go to the grievant’s representative. Other addresses to which University mailings pertaining to grievance shall be sent:

_____________________________________

_____________________________________

_____________________________________

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II. GRIEVANCE

Article(s) and Sections(s) of Agreement allegedly violated:

______________________________________________________________

______________________________________________________________

Statement of grievance (must include date of acts or omissions complained of):

Remedy Sought:

III. AUTHORIZATION

I will be represented in this grievance by (check one — representative must sign on the appropriate line):

_____ UFF _____________________________________

_____ Legal Counsel ______________________________________

_____ Myself ______________________________________

If the grievant elects self-representation or to be represented by legal counsel, the UFF shall also be notified in writing of the date, time, and place of any

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meeting or hearing called for the purpose of discussing the grievance, shall have the right to have an observer present at all meetings and/or hearings called for the purpose of discussing such grievance, and shall be sent copies of all decisions at the same time as they are sent to the other parties. No resolution of any individually processed grievance can be inconsistent with the terms of this Agreement.

I understand and agree that by filing this grievance, I waive whatever rights I may have under chapter 120 of the Florida Statutes with regard to the matters I have raised herein and under all other University procedures which may be available to address these matters.

________________________________ ____________________________

Signature of Grievant Date

(Grievant must sign if grievance is to be processed.)

The decision of the hearing officer shall be transmitted, by personal delivery with written documentation of receipt or by certified mail, return receipt requested, to the grievant, the grievant’s representative, the UFF Grievance Chair, and the Provost or designee within fifteen (15) days following the conclusion of the meeting.

UNIVERSITY OF FLORIDA

Board of Trustees–United Faculty of Florida