Membership in Good Standing Request

Your Information

PSAC ID

Name *

Home 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 *

Illness

Disability or Workplace accident

Care of family member or family obligations

Maternity, parental or adoption leave

Layoff, termination or suspension

Other - Please Specify

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, 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