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Greene County Grievance Form Please read the Greene County Employee Grievance Procedure prior to filing a grievance. Employee Information Employee's Name: Job Title: Division and Work Unit: Social Security Number: Daytime Phone: Mailing Address: Grievance Information Date of Occurrence: Have you discussed this Supervisor's Name: with your supervisor? Yes No Date(s) of discussion: Supervisor's Phone: Issue of Grievance : List specific problem issue For clarification of the issues of your grievance , please provide statements regarding the unfavorable employment decision / condition which is the subject of this grievance . (Describe what happened , when and where, how your employment has been affected, and indicate names of others involved Attach any supporting documentation.) Relief Requested: Indicate the action(s) that would resolve your grievance. My signature indicates that the information contained on this form and attachments to this form are true and factual to the best of my knowledge. Date Employee's Signature Group Grievance: If this is a group grievance, attach a list of all employees who are parties to the grievance. The list must include each employee's name, social security number, day time phone number and signature. The list must also designate one employee as spokesperson for the group. For Personnel Office Use Date Recieved County Manager's Signature Note: Grievance is not officially filed until this form is received by the County Manager.