Name of Claimant * First Name Last Name Email Address * Telephone Number * (###) ### #### Date of Violation * MM DD YYYY Time of Violation Hour Minute Second AM PM Employee Number * Seniority Date * MM DD YYYY Roster Number Present Position Held * Rate of Pay * Present Tour of Duty * Rest Days * Monday Tuesday Wednesday Thursday Friday Saturday Sunday Location of Violation * Name of Employee Claim Is To Be Filed Against * First Name Last Name Title of Employee Claim Is To Be Filed Against * Employee's Tour of Duty * Employee's Rest Days * Monday Tuesday Wednesday Thursday Friday Saturday Sunday Name of Immediate Supervisor * First Name Last Name Title of Immediate Supervisor * Immediate Supervisor's Telephone Number * (###) ### #### Identify the Violation * Include a short and concise description of the violation. Please cite Rule Numbers, if known. Submitted By (if different than the Claimant) First Name Last Name Thank you for submitting your grievance claim. A representative will be in contact with you shortly. Submit Grievance ClaimNew Jersey Transit System Board of Adjustment No. 86District Claim or Grievance to be processed
