U N I V E R S I T Y    O F    I L L I N O I S

Written Grievance Form

(For Civil Service Employees)

Grievant Name: ____________________________Date: _______________________________

Job Title: _________________________________Department: _________________________

Supervisor: _______________________________Department Head: ____________________

Office Phone: _____________________________Home Phone: _______________________



Note: Except when certain disciplinary action is the issue, an employee must initiate the Complaint Step of the grievance procedures before filing a written grievance. The grievance need not follow any particular format, but shall include a statement of the issues, the specific section(s) of Policy and Rules allegedly violated, sufficient information to clarify the issue(s) of the grievance, and the resolution sought by employee(s). The grievance also should include information about discussions with the supervisor and the unresolved issues. No issue may be raised in the written grievance that has not been discussed in the complaint step of the process, except as identified in Rule 17.01, when the grievance is filed following disciplinary action and the complaint step is omitted.

Summary of grievance:

(Use additional paper, if necessary)


Specific section(s) of Policy and Rules allegedly violated:



Remedy sought:





Signature of Grievant                                                                                             Date


Grievance Filing Guidelines Summary

See Policy and Rules Policy 17 for complete procedures

The Policy and Rules procedures apply to open range civil service employees. An employee who is a member of a collective bargaining unit should consult the applicable collective bargaining agreement for appropriate procedure, which may or may not include the use of this form.

Definition of Grievance: An alleged violation of a specific section(s) of the Policy and Rules.

Complaint Step
Grievance Procedure

Please review Policy and Rules Policy 17 in its entirety at

http://www.uihr.uillinois.edu/policy/rules.html
or
http://www.uihr.uillinois.edu/policy/rules/pdf/pr17chap.pdf