AFGE
LOCAL 507
EMPLOYEE REQUEST FOR ASSISTANCE
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Printed Name
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Date
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Yes / No Member?
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Job: Title/Position Service/Unit/Section Ext.
Tour of Duty Cell#
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Supervisor Name
Please describe your issue or problem below.





How would you like to see this resolved?


I authorize AFGE Local 507 to investigate this matter on my behalf.

Employee signature
If a grievance is needed on this matter, I (DO / I DO NOT) authorize AFGE Local 507 to file a grievance on my behalf.
Employee signature
**Please provide AFGE with copies of all pertinent documents and paperwork relating to your issue. **









Receiving Union Official
Steward Assignment:
Professional__________ Non-professional_________________
By:
Disposition/Outcome:
AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES
LOCAL 507
AFFILIATED WITH AFL-CIO
P.O. BOX 10822
RIVIERA BEACH, FLORIDA 33419
AUTHORIZATION FOR RELEASE OF INFORMATION
I am giving my authorization to AFGE to obtain copies of any and all pertinent information required from any and all my files which contains my name, and social security number. Authorization includes but not limited to my OPF, evidence file, drop files, supervisory files,
workers compensation, MIA, payroll or other (specify)________________
Employee Name______________________________________________________
Employee Signature_________________________________ Date:______________
AFGE Steward Signature____________________________ Date:______________