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Finger Lakes DDSO
Civil Service Employees Association
Local 436

Grievance Fact Sheet

[FrontPage Save Results Component]
Name Title
Seniority Date Regular Shift & Pass Days
Current Mailing Address
Home Phone                           S.S. #
Work Location Work Phone
Work Address
 E-Mail Address
Department Or Agency Supervisor
Date Of Incident
(give times, dates, etc.)

What Happened
(describe problem)

Who Was Involved
(names & titles)

Where Did It Occur
(give specific locations)

Why Is This
A Grievance

What Remedy Is
Required

Additional
Comments


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