DallasCountyFormalGrievanceForm
Name:HomeAddress:
Street
HomeTelephoneNumber:MobileNumber:
CityState,ZipCode
SCOPEOFGRIEVANCEAPPEALPROCeDURESAGrievancemaybefiledononeormoreofthefollowinggrounds.IndicatethebasisforyourgrievanceandconsultSection86-1001through86-1007oftheDallasCountyCodeforadditionalinformation.
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Improperapplicationsofrules,regulations,andprocedureso
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Unfairtreatment,includingcoercion,restraintorreprisalo
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Discriminationbasedonrace,religion,color,creed,gender,age,nationalorigin,disabilityorpoliticalaffiliation(circlespecificitemgrieved)o
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Disciplinaryactiontakenwithoutpropercauseo0Improperapplicationoffringebenefitsorimproperworkingconditions(circlespecificitemgrieved)
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o~Demotion,suspensiono~circlespecificitemgrieved)
REASON(S)FORGRIEVANCEStateyourgrievanceindetail,includingthedate(s)ofactsoromissionscausingthegrievance.Indicatethesnectttcruleorbenefitnotproperlyappliedandwhyyoubelievethedisciplinaryactiontakenisunjustorunfair.Attach
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