Virtual Employee Statement

CWA9510.ORG

**GRIEVING EMPLOYEE’S STATEMENT**

Name of Aggrieved

Personal E-mail

Personal Cell Phone #

NCS/Hire Date

Bargaining Unit/Employer

Work Location

Job Title

Date of Occurrence

Approx. Time

First Level Supervisor

District Level Manager (if known)

Please state, in your own words, exactly what happened

By checking this box, I certify all information is true and correct to the best of my knowledge.

Sending... Your message was sent successfully. Sorry, your message was not sent.