COUNTY OF BUTTE - PERSONNEL DEPARTMENT
GRIEVANCE FORM
(This Grievance Form is to be utilized by all Bargaining Units)
TO: ________________________________________	__________________________________________
	         Supervisor				Title

FROM: _______________________________________________________________________________________________
	Employee		         Title		      Department

List MOU, Board Ordinance and Personnel Rules that apply to grievance. Specify dates, facts, nature of complaint and
remedy, requested. Attach additional information if more space is necessary. Refer to your bargaining unit grievance procedure for specific details of the grievance process. The Employee Representative must be notified of any scheduled hearings. 

GRIEVANCE STATEMENT:	MOU Sections







REMEDY REQUESTED:








______________________________________________	__________________________________________
	Employee Signature or Agent			Date

Employee Representative:Butte County Employees Association, Local One										
									Steward    	


Bargaining Unit Representative:  General Unit
STEP 1 - INFORMAL/IMMEDIATE SUPERVISOR

(Presentation of Grievance to Immediate Supervisor)
An employee who believes he/she has cause for grievance shall give notice to the Immediate Supervisor, within twelve (12) days of the occurrence, or twelve (12) days of the employees’ knowledge of the occurrence in an attempt to settle the matter. 

DATE/TIME: __________________________________	SCHEDULED MEETING: ____________________________
	  (Grievance Complaint Received			      (Hearing on Grievance)

SUPERVISORS RESPONSE & REMEDY OR CORRECTION OFFERED:







____________________________________________	__________________________________________
 Immediate Supervisor’s Signature	        Date of Step 1 Response

STEP 2 - SECOND LEVEL SUPERVISOR (Optional in some Departments)

If the grievance is not settled satisfactorily at Step 1, the grievance may be sent to the Second Level Supervisor to who the Immediate Supervisor reports. A hearing will be held within seven (7) days after receipt of the decision at Step 1. 

DATE REC'D BY SECOND LEVEL SUPERVISOR: _______________  DATE OF SCHEDULED HEARING:_______________



STEP 2 STATEMENT OF POSITION & REMEDY OR CORRECTION OFFERED:









__________________________________________	__________________________________________
      Supervisor’s Signature		    	Date of Step 2 Response

STEP 3 - APPOINTING AUTHORITY

If the grievance is not settled under Step 1 or Step 2, it may be submitted to the Appointing Authority or his/her Designated Representative within seven (7) days after receipt of the written response at Step 2 or the verbal decision at Step 1, whichever is applicable. A hearing will be scheduled within seven (7) days after receipt of the written grievance.

DATE GRIEVANCE RECEIVED: _______________ DATE HEARING SCHEDULED: _______________ 

APPOINTING AUTHORITY STATEMENT OF POSITION & REMEDY OR CORRECTION OFFERED:









_________________________________________________   __________________________________________
    Appointing Authority’s Signature		  	Date of Step 3 Response

STEP 4 ABITRATION

The request for arbitration must be made in writing to the Personnel Director within seven (7) days after receipt of the Appointing Authority’s Response. 

DATE REQEUST FOR ARBITRATON FILED: _________________________________________________________


Employee Representative: ___________________________   Unit Represented: ___________________