Sonoma County Law Enforcement Association

2018 - 2019 SCLEA
Memorandum of Understanding:  
Appendix C: MOU Grievance Form

Sample MOU Grievance Form

SCLEA MEMORANDUM OF UNDERSTANDING GRIEVANCE FORM

For use only to process a grievance under the Grievance Procedure established in Article 30 of the Sonoma County Law Enforcement Association Memorandum of Understanding for employees in the Law Enforcement and Corrections/Probation Supervisory and Non-supervisory bargaining units.
NAME JOB CLASSIFICATION
DEPARTMENT/DIVISION
ASSOCIATION
STEP I

AN INFORMAL DISCUSSION WITH YOUR IMMEDIATE SUPERVISOR

Before completing the remainder of this form, an informal discussion with your immediate supervisor must take place within ten (10) days from the date of the action causing the grievance.  (Section 30.6)

SUPERVISOR’S NAME TITLE
DATE DISCUSSION HELD DATE OF SUPERVISOR’S RESPONSE
STEP II
IF THE GRIEVANCE WAS NOT RESOLVED AT STEP I, STATE IT IN WRITING AT THIS STEP AND SUBMIT THIS FORM TO YOUR IMMEDIATE SUPERVISOR WITH A COPY TO THE COUNTY’S EMPLOYEE RELATIONS MANAGER WITHIN FIVE (5) DAYS AFTER RECEIPT OF THE IMMEDIATE SUPERVISOR’S RESPONSE FROM STEP I.  (Section 30.7)
DESCRIBE GRIEVANCE (If more space is needed, use additional paper.)
DATE(S) OF INCIDENT(S)
M.O.U. ARTICLE VIOLATED
REQUESTED SOLUTION
EMPLOYEE’S SIGNATURE DATE
SUPERVISOR’S DECISION      
SIGNATURE DATE
STEP III

IF THE GRIEVANCE WAS NOT RESOLVED AT STEP II, THE ASSOCIATION MAY APPEAL THE DECISION TO THE NEXT HIGHER LEVEL OF SUPERVISION (IDENTIFIED BY THE DEPARTMENT HEAD) AND TO THE DEPARTMENT HEAD, WITH A COPY TO THE EMPLOYEE RELATIONS MANAGER WITHIN SEVEN (7) DAYS AFTER RECEIPT OF THE WRITTEN RESPONSE AT STEP II.  (30.9)

DATE OF APPEAL EMPLOYEE’S SIGNATURE
DEPARTMENT HEAD’S RESPONSE
SIGNATURE DATE
If the grievance was not settled at Step III, contact your Association representative regarding an appeal option.

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Room 116 B
Santa Rosa, CA 95403
38.465237, -122.725363

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