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:

Response Level I /_/ Level II /_/Level III /_/
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)