nteu nsw case information form
TRANSCRIPT
NAME General Academic Teacher
POSITION
FACULTY/DEPT EMPLOYMENT STATUS
PHONE (WORK) (HOME)
MOBILE EMAIL
NTEU NSW CASE INFORMATION SHEETFOR BRANCH USE
DATE OF FIRST CONTACT FORM COMPLETED BY
PERSONAL INFORMATION
MEMBERSHIP - Member Non-member
MEMBER NUMBER
MEMBER SINCE
Please tick two boxes JOINED
BACK DUES PAID
BACK DUES WAIVED (must be approved by the Branch President)
DESCRIPTION OF PROBLEM (please tick all that apply)
BRIEF DESCRIPTION OF EVENTS (giving dates and any other details)
Please attach copies of any documents that may assist us—such as payslips, medical certificates, references, letters, or any records of conversations.
ACADEMIC PROMOTION
CLASSIFICATION / RECLASSIFICATION
CONVERSION
GRIEVANCE / HARASSMENT / BULLYING
LEAVE ENTITLEMENTS
MISCONDUCT / SERIOUS MISCONDUCT
OCCUPATIONAL HEALTH AND SAFETY
ORGANISATIONAL RESTRUCTURE / REDUNDANCY
PROBATION
UNDERPAYMENT OR OTHER MONETARY ISSUE
UNSATISFACTORY PERFORMANCE / PERFORMANCE MANAGEMENT OR REVIEW
WORKLOAD
OTHER
HANDLED BY
ALLOCATED TO CASE HANDLER REFERRED TO INDUSTRIAL OFFICER
REALLOCATION REQUIRED? Yes No
REASON FOR REALLOCATION NOT CURRENT ALLOCATION
CONFLICT OF INTEREST
WORKLOAD
OTHER
NTEU NSW CASE INFORMATION SHEETFOR DIVISION USE
INITIAIL ENQUIRY RECIEVED BY
REALLOCATION
ALLOCATED TO
COMMENTS