Attachment II

 STUDENT EMPLOYMENT GRIEVANCE FORM
 
 
Name: ___________________________________________________
 
Social Security Number: _________________________________
 
Date of Submission: _____________________________________
 
Immediate Supervisor's Name: ____________________________
 
Account Manager's Name: _________________________________
 
Nature of Grievance: (Please prepare a statement explaining your grievance.)
 
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List any witnesses to support your grievance:
 
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Note: Submit this form in duplicate and in separate envelopes to your immediate supervisor and to the account manager for the account from which you are paid. Keep a copy for your file.
 
 
 
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 Student Signature