MIGS Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.PSAC IDFirst name *Middle nameLast name *Home address *All former surnamesCity *Province/Territory *Please selectAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonPostal Code * is: Employer Components/Directly Email *Telephone *Employer *Job classification *DepartmentComponents/Directly Chartered LocalsPlease selectAgriculture UnionDirectly Chartered LocalCanada Employment and Immigration UnionCustoms and Immigration UnionGovernment Services UnionNunavut Employees UnionUnion of Canadian Transportation EmployeesUnion of Health and Environment Workers​Union of National Defence EmployeesUnion of National EmployeesUnion of Northern WorkersUnion of Postal Communications EmployeesUnion of Safety and Justice EmployeesUnion of Taxation EmployeesUnion of Veterans’ Affairs EmployeesYukon Employees UnionOptions *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.I request that my status as PSAC member in good standing be maintained while I am between contracts with my academic institution (DCL university sector members only)Pay Action Request *I have submitted a Pay Action Request to my Employer so that deduction of my union dues may resume/begin.Please Choose *IllnessDisability or Workplace accidentCare of family member or family obligationsMaternity, parental or adoption leaveLayoff, termination or suspensionOther – Please SpecifyMore Details?Provide any additional details you would like to add.My leave will begin on: *My anticipated return date is: *Confirm *I confirm that during the above leave period, I will not have alternate paid employment.Submit
