Employee Grievance Rights

EMPLOYEE GRIEVANCE RIGHTS NOTICE AND ACKNOWLEDGMENT

This document explains the internal grievance procedure available to employees and the rights and protections afforded while pursuing a grievance. It sets forth required timelines, levels of review, confidentiality protections, prohibition against retaliation, and the employee's acknowledgement of receipt and consent where applicable. Employees should complete the sections below to initiate a grievance or to acknowledge receipt of these rights.

PERSONAL INFORMATION

POSITION INFORMATION

Start Date:     Salary/Hourly Rate:

EMPLOYMENT HISTORY

Most Recent Employer

Prior Employer

EDUCATION

PROFESSIONAL REFERENCES

Reference 1

Reference 2

Reference 3

LEGAL DISCLOSURES

At-Will Employment: Employment with the company is at-will unless expressly modified in a written agreement signed by an authorized company representative. Nothing in this grievance policy alters the at-will nature of employment.

Equal Opportunity: The company prohibits unlawful discrimination and provides equal opportunity for employment, promotion, and discipline without regard to protected characteristics. The grievance procedure is available to address alleged violations of this policy.

GRIEVANCE PROCEDURE AND EMPLOYEE RIGHTS

Informal Step: Employees are encouraged to first discuss concerns with their immediate supervisor or HR within calendar days of the event. The supervisor or HR will endeavor to provide a written or verbal response within calendar days after the discussion.

Formal Step: If the matter is unresolved, the employee may file a formal written grievance with HR. A formal grievance must include a clear description of the allegations, dates, names of involved parties, requested remedy, and supporting evidence. Formal grievances submitted to HR will be acknowledged in writing within calendar days and investigated promptly.

Investigation and Decision: Investigations will be conducted impartially, and where appropriate, may include interviewing witnesses and reviewing documents. A written determination will be provided within calendar days of the conclusion of the investigation, subject to extensions for good cause with written notice to the employee.

Appeal: If the employee is not satisfied with the decision, the employee may submit a written appeal to the next administrative level within calendar days after receipt of the decision. The appeal decision will be final and provided in writing within a reasonable period.

Representation: Employees may elect to be accompanied by a representative during any stage of the grievance process. Check to indicate whether you request representation:
I request to be accompanied by a representative.

Confidentiality: The company will protect confidentiality to the extent practicable consistent with conducting a fair investigation and taking appropriate corrective action. Disclosure of grievance details will be limited to those with a need to know.

Protection from Retaliation: Retaliation against any employee who files a grievance or participates in an investigation is strictly prohibited. If you believe you have experienced retaliation, notify HR immediately.

FILING A FORMAL GRIEVANCE

AUTHORIZATION & CONSENTS

By filing this grievance or acknowledging receipt of this notice, I authorize the company to investigate the facts alleged, to contact identified witnesses, and to review relevant records. I also authorize the company to contact prior employers or references as necessary to investigate issues material to the grievance.

Background Check Consent: I consent to the company conducting background or reference checks insofar as they are relevant to the grievance investigation or requested remedy.

ACKNOWLEDGMENT AND CERTIFICATION

Applicant Certification: I certify that all information provided in this form and any attachments is true, accurate, and complete to the best of my knowledge. I understand that knowingly providing false information may result in disciplinary action.

I have read and understand my rights and the grievance procedures described above, and I acknowledge receipt of this Employee Grievance Rights Notice.

HR Contact for Grievances:    Phone:

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