City Employee Mediation Request Fields with a red dot ⏺ are mandatory. Name of person requesting mediation: Labor Relations/Personnel Officer: Name: Department/Division: Phone Number: Use format xxx-xxx-xxxx E-Mail Address: Brief description of issue (s): Information Requested Employee's Name: Available Days & Times to schedule a mediation session: Pending vacations during the next month? If known or ADR will contact: Department/Division If applicable: Employee Job Title: Employee Grade: Employee E-mail Address: Employee Phone Number: Employee Salary: Captcha Submit
