申诉人:姓名性别
年龄被诉人:法定代表人:地址:请求事项:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________事实和理由:(包括证据和证据来源,证人姓名和住址等情况):_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________此致劳动争议仲裁委员会申诉人:___________(签名或盖章)__________年_______月_________日附:1.副本__________份2.物证__________份3.书证_________份