Appendix F
THE CALIFORNIA STATE UNIVERSITY
REQUEST FOR RECONSIDERATION
UNIT 4
| LEVEL OF FILING | DATE OF FILING | Campus:__________ |
Level I – Appropriate Administrator _________________________Department or Equivalent Unit
Level II – President _________________________
| Level II - Labor Relations Office of the Chancellor _____________________ |
Appropriate Administrator:____________________ |
(Only alleged violations of written system policies may be pursued to this level.)
REQUESTOR’S NAME CLASSIFICATION CAMPUS TELEPHONE NUMBER
Specific term policy/rule alleged violated:
/_/ Written campus policy/work rule:
/_/ Written systemwide policy/work rule:
Detailed description of the grounds of the alleged violation (include dates, places, times, etc.):
(If more space is needed, additional sheets may be attached.)
Proposed remedy:
Requestor’ssignature:______________________
Requestor’s address:
Name of representative:
Representative’s address and telephone number:
| Signature:_______________ | Title:_______________ | Date:_______________ |
Please provide one copy of each reconsideration request filing or response to: a) employee; b) Employer (level of filing);
c) Labor Relations, Office of the Chancellor, 401 Golden Shore, Long Beach, CA 90802; d) employee’s representative.
(Revised 2005)