申訴人:姓名性別
年齡被訴人:法定代表人:地址:請求事項:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________事實和理由:(包括證據和證據來源,證人姓名和住址等情況):_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________此致勞動爭議仲裁委員會申訴人:___________(簽名或蓋章)__________年_______月_________日附:1.副本__________份2.物證__________份3.書證_________份