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reason_choice
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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:
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Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
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7
8
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10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2017
2018
2019
2020
2021
My anticipated return date is:
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2017
2018
2019
2020
2021
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.
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