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