MICHIGAN AFSCME COUNCIL 25
ARBITRATION SUBMISSION FORM
Local No Local/Chapter Name
County Local Grievance Number
Grievant
Mr. / Ms. Home Phone
Address Work Phone
City/State Seniority Date
Zip Code Classification
Submitting Officer
Mr. / Ms. Home Phone
Title Work Phone
(i.e. president, chapter chairperson, steward)
Address Local Phone
City/State/Zip Fax Number
President or Chapter Chair if not Submitting Officer
Mr. / Ms. Home Phone
Title Work Phone
Address Cell Phone
City/State/Zip Fax Number
Employer Representative
Mr. / Ms. Title
Address Phone
City/State/Zip Fax
The submitting officer only must completely fill in the above information legibly. Lack of information will cause the submission form to be returned to the submitting officer without further processing. When submitting to staff representatives, all pertinent grievance papers, disciplines, postings, seniority lists, etc., must be included along with one copy of the contract. Submissions must be received at least ten (10) calendar days prior to the deadline for filing the arbitration demand if Council 25 is responsible for sending in the demand. The local union/chapter will be held responsible for any filing fees of cases that are untimely submitted by the local/chapter, or cases that are rejected by Council 25.
Arbitration Department Use Only
Log Number Date Received
STAFF REPRESENTATIVE SYNOPSIS & RECOMMENDATION
(to be completed by Staff Representatives Only)
Employer Counsel
Mr / Ms Title
Address Phone
City/State/Zip Fax Number
Case Submitted to the Following Agency
AAA Deadline AD HOC Deadline
MERC Deadline Panel Deadline
FMCS Deadline STATE EMP Deadline
Pre-Selected Arbitrator
ISSUE: (Check appropriate category)
10 Supervisors
11 Veterans & Military Service
12 Discrimination - Union Activity
12-01 Racial
12-02 Religious
12-03 Sexual
13 Employee Status
13-01 Temporary
13-02 Part-Time
14 Employee Benefits
14-01 Holiday(incl. holiday work scheduling)
14-02 Vacations
14-03 Leaves (Including denial of sick/annual leaves)
14-04 Pensions
14-05 Welfare Plans
14-06 P.A. 414 and Workers' Comp.
14-07 Other (empl. vehicle, safety clothing)
14-08 Change of "R" Days
15 Job Protection
15-01 Layoff/Elimination of Job
15-02 Rehire/Recall
15-03 Seniority
15-04 Work Assignment - includes working in a higher classification
15-05 Work Transfer
15-06 Subcontracting
15-07 Staffing and/or Safety/Health
16 Promotion
17 Job Vacancy/Posting
18 Work Rules
19 Demotion
20 Severance Pay
22 Arbitrability - Time Limits
22-01 Substantive
23 Wages
23-01 Other Compensation for Serv.
24 Hours
25 Overtime
26 Premium Pay
27 Discipline
27-01 Oral Reprimand/Counseling
27-02 Written Reprimand/Counseling
28 Suspension
28-01 Abuse of Patients/Neglect
28-02 Threats/Assaults
28-03 Excessive Tardiness
28-04 Excessive Absenteeism
28-05 Insubordination
28-06 Poor Work Performance
28-07 Substance Abuse
28-08 Misconduct
28-09 Other (Suspension Only)
28-10 Refusal to Work Mandatory OT
28-11 Falsification of records
28-12 Fighting
29 Discharge
29-01 Failure to Report/No Call, No Show
29-02 Abuse of Patients/Neglect
29-03 Threats/Assaults
29-04 Insubordination
29-05 Theft
29-06 Excessive Tardiness
29-07 Excessive Absenteeism
29-08 Substance Abuse
29-09 Neglect of Duty
29-10 Other (Discharge Only)
29-11 Civil Service Leave of Absence Denial
29-12 Poor Work Performance
29-13 Falsification of Records
29-14 Fighting
30 Stipulated Award
31 Other
32 Service Ratings
33 Lost Time
34 Harassment
35 Civil Service Position Abolishment or Posting & Bidding Procedure
36 Violation of Grievance Procedures
Explanation of case and contract violations: (Attach additional sheets if needed)
Accept Color Code
Staff Representative Date Reject Upper Peninsula Peach
City of Detroit Buff
State Civil Service Pink
Staff Supervisor Univ. of Michigan Green
All Others Yellow
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