RURAL
CARRIER REQUEST FOR ACTION
RURAL
CARRIER REQUEST FOR ACTION
NAME:__________________________________________________________________________
POST
OFFICE:____________________________________________________________________
POSTMASTER/SUPERVISOR
NOTIFIED:_____________________________________________
DATE
NOTIFIED:______________________________________
THIS FORM IS TO OFFICIALLY REQUEST THE FOLLOWING ACTION(S):
___ 1. I request that my route be adjusted as soon as possible in accordance with the applicable
adjustment criteria (M-38, Route Adjustment Handbook, Automation MOUs and/or District
Policy accepted by the
___ 2. I request that I be granted my contractual right under Article 9.2.C.6 of the USPS/NRLCA
National Agreement to my Saturday relief day and hereby notify you that unless specified I
do not agree to work my Saturday relief day.
___ 3. I request that I be granted auxiliary assistance for combined (regular and relief employee)
work time that exceeds 57.36 hours per week and up to my evaluated route time. (For Over-
burdened Routes)
___ 4. I request that I be granted auxiliary assistance and / or compensation for cleaning up surplus
and / or curtailed mail left from my relief day and / or leave day.
___ 5. I request that a relief employee be assigned as the leave replacement on my route.
___ 6. I request a formal review of my DPS mail, due to a decrease in the quality and/or quantity as compared to my
most recent mail count.
___ 7. I request_________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
DATE:__________________________ SIGNATURE:________________________________________________
Original to Postmaster/Supervisor
1 copy to Assistant State Steward