CWA - Local 7803 | Statement of Occurrence

STATEMENT OF OCCURRENCE

WARNING: CWA Local 7803 represented employees only. Unauthorized use prohibited. Submitting this form records your IP address.

Please fill out all required fields with as much information as you can. Your statement will be automatically forwarded to the Local which will be reviewed as soon as possible. Please contact the Local or your Steward for more information.

* indicates required entry

*Name (first, last):
*Company
Work Tel. #
Pager/Cell #
*Home Address
*City, State, Zip
*Home Tel. #
Email Address:
Seniority Date
Department
*Title
*Supervisor's Name
*Date of Occurrence (month/day/year)
*The following is a statement of what happened to me on "Date of Occurrence":
*Please read and check button to authorize a "signed & dated" statement of occurence	I hereby give consent to the inspection by authorized Union Representatives any records which may affect my employment. This authorization is given in accordance with the agreement between the Union and the Company.