Membership in Good Standing Request

Your Information

PSAC ID

Name *

Address *

Address 2

City *

Province/Territory *

Postal Code *

Email *

Telephone *

Employer *

Department

Component

reason_choice *

I request that my status as PSAC member in good standing be maintained while I am on unpaid leave.

I request that my status as PSAC member in good standing be maintained until the Phoenix pay system has reinstated payment of my union dues.

Please Choose *

Disability or illness

Workplace accident

Care of family member or family obligations

Maternity, parental or adoption leave

Layoff, termination or suspension

More Details?

Provide any additional details you would like to add below.

My leave will begin on: *

Month

Day

Year

My anticipated return date is: *

Month

Day

Year

I confirm that during the above leave period leave I will not have alternate paid employment. *

I confirm that during the above leave period leave I will not have alternate paid employment.

pay_action_request *

I have submitted a Pay Action Request to my Employer so that deduction of my union dues may resume/begin.

Leave this field blank