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Which agency, department are you employed with?
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Accessibility Standards Canada
Administrative Tribunals Support Service of Canada
Agriculture and Agri-Food Canada
Atlantic Canada Opportunities Agency
Canada Border Services
Canada Revenue Agency
Canada School of Public Service
Canadian Centre for Occupational Health and Safety
Canadian Dairy Commission
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Office of the Secretary to the Governor General
Office of the Senate Ethics Officer
Office of the Superintendent of Financial Institutions Canada
Parks Canada
Parole Board of Canada
Patented Medicine Prices Review Board Canada
Privy Council Office
Public Health Agency of Canada
Public Prosecution Service of Canada
Public Safety Canada
Public Service Commission of Canada
Public Services and Procurement Canada
RCMP External Review Committee
Royal Canadian Mounted Police
Secretariat of the National Security and Intelligence Committee of Parliamentarians
Senate
Shared Services Canada
Social Sciences and Humanities Research Council of Canada
Statistics Canada
Statistics Survey Operations
Supreme Court of Canada
Telefilm Canada
The National Battlefields Commission
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Transportation Safety Board of Canada
Treasury Board of Canada Secretariat
Veterans Affairs Canada
Veterans Review and Appeal Board
Western Economic Diversification Canada
Women and Gender Equality Canada
Who is your current or former employer?
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Accessibility Standards Canada
Administrative Tribunals Support Service of Canada
Agriculture and Agri-Food Canada
Atlantic Canada Opportunities Agency
Canada Border Services
Canada Revenue Agency
Canada School of Public Service
Canadian Centre for Occupational Health and Safety
Canadian Dairy Commission
Canadian Food Inspection Agency
Canadian Grain Commission
Canadian Heritage
Canadian High Artic Research Station
Canadian Human Rights Commission
Canadian Institutes of Health Research
Canadian Intergovernmental Conference Secretariat
Canadian Northern Economic Development Agency
Canadian Nuclear Safety Commission
Canadian Radio-television and Telecommunications Commission
Canadian Security Intelligence Service
Canadian Space Agency
Canadian Transportation Agency
Civilian Review and Complaints Commission for the RCMP
Communications Security Establishment Canada
Copyright Board Canada
Correctional Service Canada
Courts Administration Service
Crown-Indigenous Relations and Northern Affairs Canada
Department of Finance Canada
Department of Justice
Economic Development Agency of Canada for the Regions of Québec
Elections Canada
Employment and Social Development Canada
Environment and Climate Change Canada
Farm Products Council of Canada
Federal Economic Development Agency for Northern Ontario
Federal Economic Development Agency for Southern Ontario
Financial Consumer Agency of Canada
Financial Transactions and Reports Analysis Centre of Canada
Fisheries and Oceans Canada
Global Affairs Canada
Health Canada
House of Commons (Employees)
House of Commons (Members)
Immigration and Refugee Board of Canada
Immigration, Refugees and Citizenship Canada
Impact Assessment Agency of Canada
Indian Oil and Gas Canada
Indigenous Services Canada
Infrastructure Canada
Innovation, Science and Economic Development Canada
International Joint Commission (Canadian Section)
Law Commission of Canada
Leaders Debate Commission
Library and Archives Canada
Library of Parliament
Military Grievances External Review Committee
Military Police Complaints Commission of Canada
National Defence
National Energy Board
National Film Board
National Research Council Canada
National Security and Intelligence Review Agency
Natural Resources Canada
Natural Sciences and Engineering Research Council of Canada
Northern Pipeline Agency Canada
Office of the Auditor General of Canada
Office of the Commissioner for Federal Judicial Affairs Canada
Office of the Commissioner of Lobbying of Canada
Office of the Commissioner of Official Languages
Office of the Communications Security Establishment Commissioner
Office of the Conflict of Interest and Ethics Commissioner
Office of the Correctional Investigator
Office of the Information Commissioner of Canada
Office of the Intelligence Commissioner
Office of the Public Sector Integrity Commissioner of Canada
Office of the Secretary to the Governor General
Office of the Senate Ethics Officer
Office of the Superintendent of Financial Institutions Canada
Parks Canada
Parole Board of Canada
Patented Medicine Prices Review Board Canada
Privy Council Office
Public Health Agency of Canada
Public Prosecution Service of Canada
Public Safety Canada
Public Service Commission of Canada
Public Services and Procurement Canada
RCMP External Review Committee
Royal Canadian Mounted Police
Secretariat of the National Security and Intelligence Committee of Parliamentarians
Senate
Shared Services Canada
Social Sciences and Humanities Research Council of Canada
Statistics Canada
Statistics Survey Operations
Supreme Court of Canada
Telefilm Canada
The National Battlefields Commission
Transport Canada
Transportation Safety Board of Canada
Treasury Board of Canada Secretariat
Veterans Affairs Canada
Veterans Review and Appeal Board
Western Economic Diversification Canada
Women and Gender Equality Canada
Which agency, department were you formally employed with?
Select a value
Accessibility Standards Canada
Administrative Tribunals Support Service of Canada
Agriculture and Agri-Food Canada
Atlantic Canada Opportunities Agency
Canada Border Services
Canada Revenue Agency
Canada School of Public Service
Canadian Centre for Occupational Health and Safety
Canadian Dairy Commission
Canadian Food Inspection Agency
Canadian Grain Commission
Canadian Heritage
Canadian High Artic Research Station
Canadian Human Rights Commission
Canadian Institutes of Health Research
Canadian Intergovernmental Conference Secretariat
Canadian Northern Economic Development Agency
Canadian Nuclear Safety Commission
Canadian Radio-television and Telecommunications Commission
Canadian Security Intelligence Service
Canadian Space Agency
Canadian Transportation Agency
Civilian Review and Complaints Commission for the RCMP
Communications Security Establishment Canada
Copyright Board Canada
Correctional Service Canada
Courts Administration Service
Crown-Indigenous Relations and Northern Affairs Canada
Department of Finance Canada
Department of Justice
Economic Development Agency of Canada for the Regions of Québec
Elections Canada
Employment and Social Development Canada
Environment and Climate Change Canada
Farm Products Council of Canada
Federal Economic Development Agency for Northern Ontario
Federal Economic Development Agency for Southern Ontario
Financial Consumer Agency of Canada
Financial Transactions and Reports Analysis Centre of Canada
Fisheries and Oceans Canada
Global Affairs Canada
Health Canada
House of Commons (Employees)
House of Commons (Members)
Immigration and Refugee Board of Canada
Immigration, Refugees and Citizenship Canada
Impact Assessment Agency of Canada
Indian Oil and Gas Canada
Indigenous Services Canada
Infrastructure Canada
Innovation, Science and Economic Development Canada
International Joint Commission (Canadian Section)
Law Commission of Canada
Leaders Debate Commission
Library and Archives Canada
Library of Parliament
Military Grievances External Review Committee
Military Police Complaints Commission of Canada
National Defence
National Energy Board
National Film Board
National Research Council Canada
National Security and Intelligence Review Agency
Natural Resources Canada
Natural Sciences and Engineering Research Council of Canada
Northern Pipeline Agency Canada
Office of the Auditor General of Canada
Office of the Commissioner for Federal Judicial Affairs Canada
Office of the Commissioner of Lobbying of Canada
Office of the Commissioner of Official Languages
Office of the Communications Security Establishment Commissioner
Office of the Conflict of Interest and Ethics Commissioner
Office of the Correctional Investigator
Office of the Information Commissioner of Canada
Office of the Intelligence Commissioner
Office of the Public Sector Integrity Commissioner of Canada
Office of the Secretary to the Governor General
Office of the Senate Ethics Officer
Office of the Superintendent of Financial Institutions Canada
Parks Canada
Parole Board of Canada
Patented Medicine Prices Review Board Canada
Privy Council Office
Public Health Agency of Canada
Public Prosecution Service of Canada
Public Safety Canada
Public Service Commission of Canada
Public Services and Procurement Canada
RCMP External Review Committee
Royal Canadian Mounted Police
Secretariat of the National Security and Intelligence Committee of Parliamentarians
Senate
Shared Services Canada
Social Sciences and Humanities Research Council of Canada
Statistics Canada
Statistics Survey Operations
Supreme Court of Canada
Telefilm Canada
The National Battlefields Commission
Transport Canada
Transportation Safety Board of Canada
Treasury Board of Canada Secretariat
Veterans Affairs Canada
Veterans Review and Appeal Board
Western Economic Diversification Canada
Women and Gender Equality Canada
Which agency, department or non-gov’t workplace are you employed with?
*
Select a value
TB
Canada Revenue Agency (CRA)
Canada Food Inspection Agency (CFIA)
Parks Canada
A college or university
A territorial government (i.e. Yukon, Nunavut or Northwest Territories)
Another employer
Please specify
Job Classification
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Work Address
Date of hire
Nature of your request
Which PSAC component do you belong to, or do you belong to a Directly Chartered Local (DCL)?
*
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Agriculture (AGR)
Canada Employment & Immigration Union (CEIU)
Customs Immigration Union (CIU)
Union of Health and Environment Workers (UHEW)
Government Services Union (GSU)
Union of National Employees (UNE)
Nunavut Employees Union (NEU)
Union of Canadian Transportation Employees (UCTE)
Union of National Defence Employees (UNDE)
Union of Northern Workers (UNW)
Union of Postal Communications Employees (UPCE)
Union of Taxation Employees (UTE)
Union of Veterans’ Affairs Employees (UVAE)
Yukon Employees Union (YEU)
Directly Chartered Local (DCL) – no component
Not sure
Do you have a Phoenix pay grievance?
Yes
No
If so, what is your grievance number?
Have you filed a severe impact claim?
Yes
No
Do you have a copy of your severe impact claim application? If so, please attach it here
Click or drag a file to this area to upload.
Files must be less than 32MB. Allowed file types: pdf docx.
Do you have a copy of your severe impact claim decision letter? If so, please attach it here
Click or drag a file to this area to upload.
Files must be less than 32MB. Allowed file types: pdf docx.
If you received an overpayment letter please provide us with a copy here:
Click or drag a file to this area to upload.
Has Annex B has been submitted?
Yes
No
If you already replied to the overpayment letter (Annex B) please provide us with a copy here:
Click or drag a file to this area to upload.
Message
Please explain why you wish to appeal your severe impact claim
Please provide a brief description of your pay issue(s)
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