University of North Carolina General Administration

University of North Carolina – General Administration SPA Grievance Filing Form - Step 2 Grievance Panel Hearing

Section I: Grievant Personnel Information

Grievant’s Full Name:

Division/Department: Position Title:

Home Address: Home Phone: Work Phone:

Immediate Supervisor’s Title: Email Address:

Section III: Description of Grievance

I am requesting a Step 2 Hearing Panel due to Mediation Impasse for the reason(s) listed below (attach additional sheet(s) if necessary):

Desired Relief or Resolution:

Section IV: Statement of Retaliation

Employees have the right to use this procedure free from threats or acts of retaliation, interference, coercion, restraint, discrimination, or reprisal. Employees may not be retaliated against for participating in a grievance as a grievant, a respondent, a witness, a support person, or as a grievance panel member. Section V: Certification

UNC GA Human Resources Revised: 3/23/2015 University of North Carolina – General Administration SPA Grievance Filing Form - Step 2 Grievance Panel Hearing

I hereby certify that all information submitted on this Step 2 Filing form is true and complete to the best of my knowledge and belief. I understand that if I continue to be employed by the University during the resolution process of this grievance, I must continue to meet the performance and conduct expectations of my employment. Grievant’s Signature Date:

Section VI: Next Steps The Grievance Coordinator will review your submission for eligibility.

If you are appealing to Step 2 Hearing:  The Grievance Coordinator will schedule a hearing within thirty-five (35) calendar days of the date you submit this form. Your department will designate a “Respondent” who will participate in the hearing with you. You will receive additional information regarding the hearing process from the Grievance Coordinator in advance of the hearing date.  The Hearing Panel will consider the evidence provided and make a recommendation to the President (or designee), who will make a final decision on the grievance for the University.

Mail this form to: Human Resources, UNC General Administration, PO Box 2688, Chapel Hill, NC 27515 Hand Deliver form to: Human Resources, UNC General Administration, 910 Raleigh Road, Chapel Hill, NC 27514 Fax this form to: 919-843-2318

For Human Resources Use Only: Received by: Date:

Did Step 1 Mediation Result in Impasse: Date of Mediation:

Yes No Is the Step 2 form filed timely: Yes No

UNC GA Human Resources Revised: 3/23/2015