AFA-CWA Council 57

Please fill out all questions. Missing answers can/will cause delays in the grievance process. To assist us in investigating your questionnaire, please leave detailed responses.

Note: Per section 19 of the contract, disciplinary grievances must be filed within 10 business days and non-disciplinary grievances must be filed within 30 calendar days.

If you have any issues submitting this form, contact the AFA Council 57 Website administrator at webmaster@afaairtran.com. Please leave an email detailing any error messages you receive.

Fileds with an * are required for submission.

First and Last Name*
Phone Number*
Email Address*
Employee Number*
Date of Hire* (mm/dd/yy)
Base	ATL MCO MKE
Today's Date* (mm/dd/yy)
Please provide us with the date that the incident/violation occured or the date you received a disciplinary write-up.
If applicable, what page and section of the contract have been violated?
Please explain the events that occurred in a concise and factual manner.
Have you attempted to remedy the situation on your own?	Yes No
If you checked yes above, what have you attemped to do to remedy this situation on your own? Please give specifics. For example, emails, phone calls, persons you've spoken to, etc.
What were the results of your own attempts to remedy this situation?
If this is a pay protection issue, you must first complete the Crew Pay Discrepancy Form and fax to 407 318 5917.	Have you performed this step? Yes No N/A
If you checked yes above, please answer the following: If you feel the pay discrepancy was denied in error by payroll, please state the reason given by payroll for denial.
Do you have any documents supporting your claim?	Yes No N/A Note: If you checked yes, please retain your documentation until it is requested by a grievance representative.
What remedies are you seeking?
Please acknowledge the following statement by clicking I agree.	By submitting this form, I authorize the Association of Flight Attendants-CWA, AFL-CIO, MEC Grievance Committee to investigate and review my personnel file. I agree
Please acknowledge the following statement by clicking I agree	Please note the following: This is NOT AN OFFICIAL GRIEVANCE; this is a fact-finding form and is used to begin the grievance investigation. By submitting this form, you authorize the Association of Flight Attendants, AFL-CIO, MEC Grievance Committee to investigate and review your personnel file. A grievance representative will contact you and if a formal grievance is filed, you will receive a receipt informing you which Grievance Representative will be contacting you. If you do not hear from a grievance rep within 14 days, please contact Stephen Grimaldi at grimal9@gmail.com or Alison Head at vplec57@gmail.com. Any duplicate of this form given independently to a Grievance Rep will NOT be addressed. I understand the above statement

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May 23, 2013

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