Grievance Ticket Submission Form

Please fill this form out in its entirety using specifics and facts. This is the first part of the Grievance process.

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Employee Information

Employee Info 1

Name

First

Last

Domicile

Employee Info 2

Employee #

12345

Pay Rate

Date of Hire

mm/dd/yyyy

Phone #

Email (personal email only please, not 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.

Layout

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

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