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          Teamsters Local No. 2

Employee Name *
Phone # *
DATE OF CONTRACT VIOLATION *
Center Location *
Employee ID # *
Mailing Address *
Opt-in date
Type of Claim
Discharge
Pay Claim
Suspension
Seniority Violation
Excessive Overtime
Other
Description of Grievance (Who, What, When, Where, Why, Witnesses) *
Was a discussion had with a supervisor regarding the violation? (Who, Date, Time, Union Steward or other witnesses) *
Contract Article Violated *
Remedy Requested *
Signature

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For Office Use Only
This form is the sole possession of Teamsters Local No. 2. Only an authorized representative of Teamsters Local No. 2 has the right to withdraw or settle this grievance.



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Teamsters Local 2
3345 Harrison Ave.
Butte, MT 59701
  406-494-2747

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