DGBA(EXHIBIT) - PERSONNEL-MANAGEMENT RELATIONS: EMPLOYEE COMPLAINTS/GRIEVANCES

Garland ISD Employee Complaint Form

Level One ____Level Two ____Level Three ____

To file a formal complaint, complete this form in its entirety and submit it by hand delivery, fax, or U.S. Mail to the appropriate administrator within the time frame established in DGBA(LOCAL). All complaints will be heard in accordance with DGBA(LEGAL) and (LOCAL).

Name:

Address:

Telephone number (work): (home or cell):

Position: Campus/Department:

Will you have a representative present at the Level One hearing? ___ Yes ___ No

If you answered yes, please identify your representative.

Name:

Address:

Telephone number:

List the policy allegedly violated, misinterpreted, or misapplied.

Grievance filed against?

Describe the circumstance or decision causing your complaint. Cite specific, factual details. (For Level Two and Level Three hearings, attach the previous complaint form.)

List the date(s) of the circumstance(s) or decision causing your complaint.

Explain how you have been harmed by this circumstance or decision.

Describe efforts you have made to resolve your complaint informally.

With whom did you communicate? Date:

What was the response?

Describe the remedy you are seeking for this complaint.

Employee signature:

Signature of employee's representative:

Date of filing:

Attach any documents you believe will support the complaint. If documents are unavailable upon submission, they may be presented no later than the Level One hearing. The scope of the grievance and/or the relief sought may not change after the Level One hearing.

A complaint form that is incomplete may be dismissed but may be resubmitted when all required information is completed if the resubmission is within the designated time for filing a complaint.

A resolved grievance may not be appealed to the next level.

Garland ISD

DGBA(EXHIBIT)-X

LDU 2015.03

DATE ISSUED: 7/15/2015