Complaint Form Pdf Download - Free Download
4.2, 3084 votes
Please vote for this template if it helps you.
Complaint Form Pdf Download
Complaint Form Pdf Download
Human Resources
PPSM 70 Complaint (Required by Berkeley Procedure 70)
A. Complainant
Last Name:
First Name:
Middle Initial:
Department:
Payroll Title:
Hire Date (M/D/Y):
Home Address:
Home/Cell Phone No.:
Work Phone No.:
Email Address:
B. Supervisor
Last Name:
First Name:
Email Address:
Work Phone No.:
C. Representative (if any)
Last Name:
First Name:
Address:
Phone No.:
Email Address:
D. Informal Resolution
Please attach a statement that identifies and details your informal resolution attempt(s), including the dates of such attempts, and
the name(s) of the person(s) contacted.
E. Statement
Please attach a statement detailing:
(1) which University policies were violated, including the specific sections of such policies;
(2) the specific management act(s) that gave rise to your complaint;
(3) when the act(s) occurred (or when you became aware of such act(s));
(4) how the act(s) violated the specified University policies; and
(5) how you were adversely affected.
F. Remedy
Please describe your requested remedy.
Date:
For Human Resources Use Only
Complaint No.: Date Received:
Appealable to Step II
Eligible for Factfinding
Appealable to Step III
PPSM 70 Complaint Form Revised 6/2014
Complaint Form Pdf Download Previous Page Complaint Form Pdf Download Next Page
source: hrweb.berkeley.edu
Complaint Form Pdf Download
Previous

1/2

Next