Petition For Hearing On Grievance

SD EForm - 1656 V1 SD DEPARTMENT OF LABOR AND REGULATION SOUTH DAKOTA DEPARTMENT OF LABOR DIVISION OF LABOR AND MANAGEMENT DIVISION OF LABOR AND MANAGEMENT , Petitioner, vs. , Respondent. 1. Employee or Employee Organization: Name of contact person: Address: Telephone: Employer: Name of contact person: Address: Telephone: HF No. PETITION FOR HEARING ON GRIEVANCE 2. Are you represented by a union for contract negotiation purposes? Y N Has the Respondent adopted an ordinance or resolution establishing a grievance procedure for all its employees? Y N STATEMENT OF GRIEVANCE: 1 ______________________ _________ Signature Date DOL-LM 8/02 American LegalNet, Inc. www.FormsWorkFlow.com