Name of the person making the allegation: __________

Address: __________

E-mail address: __________

Name of the employee or deputy head against whom the allegation is made: __________

Organization in which that employee or deputy head is employed: __________

Address: __________

Section of the Act contravened (check one):

 s. 113(1) An employee engaged in a political activity that impaired the employee’s ability to perform his or her duties in a politically impartial manner.

 s. 114(1) An employee sought nomination as a candidate in a federal, provincial or territorial election without obtaining permission from the Public Service Commission.

 s. 114(2) An employee was a candidate in a federal, provincial or territorial election without obtaining permission from the Public Service Commission before the election period.

 s. 114(3) An employee was a candidate in a federal, provincial or territorial election during an election period but did not obtain a leave of absence without pay from the Public Service Commission.

 s. 115(1) An employee sought nomination or was a candidate in a municipal election without obtaining permission from the Public Service Commission.

 s. 117 A deputy head engaged in a political activity other than voting in an election.

Description of alleged contravention (please provide as much detail as possible):

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