Public Grievances – NJ de jure Assembly

The people have the right to assemble together, consult to the common good, to make their opinion to their representatives, and to petition for redress of grievances. ---NJ Constitution Article 1.18

NJDJA PUBLIC GRIEVANCE FORM

NAME: *

First

Last

ADDRESS: *

Enter Your Street, City, State and Zipcode

COUNTY: *

EMAIL: *

PHONE: *

If you are the Grievant, Please provide your Full Name.

Are You A Member Of the New Jersey de jure Assembly?

IF YES, WHAT IS YOUR POSITION IN THE ASSEMBLY? *

DETAILS OF EVENT LEADING TO GRIEVANCE: *

Enter Date, Time And Location Of Event

WITNESSES if applicable:

List the Names, email and phone number of all witnesses.

ACCOUNT OF EVENT: *

Provide a detailed account of the occurrence. Include the names of any additional persons involved.

VIOLATIONS *

Provide a list of any policies, procedures, or guidelines you believe have been violated in the event described.

PROPOSED SOLUTION:

Please retain a copy of this form for your own records. As the grievant, please provide your signature below, as it indicates that the information you've included on this form is truthful.