Grievance Form – Horizon Air

Grievance Submission Form

Please fill this form out in its entirety using specifics and facts.

Employee Information

Name *

First

Last

Domicile *

Employee # *

12345

Date of Hire *

mm/dd/yyyy

Pay Rate *

Phone # *

Email (Personal email only please. Do not use company email.) *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Grievance Information

Describe in detail the action/s giving rise to the grievance. Be as specific as possible so the AFA Grievance committee can determine the merit of a possible grievance. Please indicate if you have supporting documentation or attachment's. *

Inflight Supervisor Contacted *

Date / Time of Supervisor Contact *

Date

Time

Outcome of Conversation with Supervisor *

Article # *

Page # in Contract. *

Digital Signature and Date

I hereby authorize the Association of Flight Attendants (AFA-CWA) and/or it's representatives to act on my behalf in the disposition, discussion, and resolution of this grievance. Furthermore, as my representative, AFA-CWA is hereby granted full access to any and all confidential employee files, including but not limited to: Inflight Supervisor's files and notes, confidential employee files, disciplinary notices or letters of reprimand, regardless of format (i.e. electronic or written) relevant to this complaint. Sign and Date:

Full Name *

first, last

Date *