Before the Public Service Labour Relations Board

Re:

• 1. 

  Parties:
• 2. 

  TAKE NOTICE that the Board will hear the parties concerned in the at on the day of , 20, at o’clock in the noon.
• 3. 

  AND FURTHER TAKE NOTICE that if you fail to attend at the hearing or at any continuation thereof, the Board may dispose of the matter on the evidence and representations placed before it at that hearing without further notice to you.

Dated at , this day of , 20

Executive Director

Before the Public Service Labour Relations Board

BETWEEN:

RE:

TO:

At the request of , you are hereby summoned and required to attend before the Public Service Labour Relations Board at a hearing to be held at on the day of , 20, at the hour of o’clock in the noon, and so from day to day until the hearing is concluded or you are otherwise excused by the Board, to give evidence on oath relevant to the matters in question in the proceeding, and to bring with you and to produce at the aforesaid time and place

Dated at , this day of , 20

For the Board

Before the Public Service Labour Relations Board

(If necessary, attach additional pages of same size of paper)

• 1. 

  Complainant, name and address:

  Respondent, name and address:

• 2. 

  The complainant complains that
  • Footnote ^*(a) 

    the employer,
  • Footnote ^*(b) 

    a person acting on behalf of the employer,
  • Footnote ^*(c) 

    an employee organization,
  • Footnote ^*(d) 

    a person acting on behalf of an employee organization, has failed to .......

  (STATE NATURE OF FAILURE COMPLAINED OF, SPECIFYING RELEVANT SECTION OF THE ACT, PROVISION OF ARBITRAL AWARD, DECISION OF ADJUDICATOR OR REGULATION RESPECTING GRIEVANCES.)

  • Return to footnote ^*Strike out items not applicable.

• 3. 

  The complainant requests that the Board issue the following order

  .......

  (state relief sought)

SEE SUBSECTION 13(2) OF THE ACT

• 4. 

  The following is a concise statement of each act or omission complained of: (Give dates and names of persons involved.)
• 5. 

  The following steps have been taken by or on behalf of the complainant for the adjustment of the matters giving rise to the complaint:
• 6. 

  Other matters considered relevant:

Dated at , this day of ,

(Signature of complainant)

Before the Public Service Labour Relations Board

(If necessary, attach additional pages of same size of paper)

• 1. 

  Applicant, name and address:

Employer, name and address:

• 2. 

  Where the applicant is a council of employee organizations, state the name and address of each constituent employee organization:
• 3. 

  Detailed description of the unit of employees of the employer that the applicant proposes as appropriate for collective bargaining:
• 4. 

  The grounds on which the applicant intends to rely in support of its proposal that the bargaining unit described in section 3 is appropriate:
• 5. 

  Estimate number of employees in the proposed bargaining unit:
• 6. 

  The name and address of any employee organization that has been certified as bargaining agent for any of the employees in the unit proposed in section 3:
• 7. 

  Other matters considered relevant in support of this application:

Dated at , this day of , 20 and signed on behalf of the applicant by,

(Signature)

(Office held in employee organization)

I declare that the answers and information contained in the foregoing application are true in substance and in fact. I further declare that I have been duly authorized to make this application. And I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath, and by virtue of the Canada Evidence Act.

Declared by the said

before me at , in the County of , in the Province of , this day of , 20

(Signature)

a Commissioner, etc

(To be declared before a Commissioner for taking affidavits or any other person authorized by law to administer an oath.)

Before the Public Service Labour Relations Board

• 1. 

  Applicant, name and address:

Employer, name and address:

• 2. 

  TAKE NOTICE that the applicant, on , 20, made an application to the Public Service Labour Relations Board for certification as bargaining agent of the employees in the bargaining unit described in the application as follows:
• 3. 

  The terminal date fixed for this application is the day of , 20
• 4. 

  Any employee or group of employees affected by the application who wishes to make representations to the Board in opposition to this application is required to file with the Board in writing a concise statement of opposition which statement shall

• (a) be signed by the employee or each member of the group of employees;

• (b) be accompanied by a return mailing address of the employee or representative of the group of employees; and

• (c) be filed not later than the terminal date (see Note, below).

• 5. 

  The Board will accept only written statements that comply with the requirements set forth in section 4.
• 6. 

  Any employee or group of employees who has filed a written statement with the Board in accordance with section 4 will be notified of any hearing that the Board may direct in the matter. Any person so notified may attend and be heard in person or may authorize a representative to appear in his place. The Board may dispose of the application without further notice where a party who has been notified of the hearing fails to attend.
• 7. 

  No oral evidence of opposition by employees to certification of the applicant will be accepted by the Board except to identify and substantiate the written statement of opposition.
• 8. 

  (Where the applicant is a council of employee organizations) AND FURTHER TAKE NOTICE that the applicant has filed with the Board certain documents on which it intends to rely to satisfy the Board that each of the employee organizations that is a constituent member of the council has vested appropriate authority in the council to enable it to discharge the responsibilities of a bargaining agent. These documents are available for inspection at the offices of the Board at Ottawa, Ontario, during business hours.

Dated at , this day of , 20

Executive Director

Before the Public Service Labour Relations Board

(If necessary, attach additional pages of same size of paper)

• 1. 

  Applicant, name:

Employer, name and address:

• 2. 

  Indicate the total number of persons in the proposed bargaining unit as described in the application.
• 3. 

  If you propose a bargaining unit different from the one proposed by the applicant,

• (a) Provide a detailed description of the unit of employees that you propose as appropriate for collective bargaining.

• (b) Provide the grounds on which you intend to rely to show that the bargaining unit described in the application is not appropriate or that the bargaining unit proposed in paragraph (a) is more appropriate than the one proposed by the applicant.

• (c) Indicate the total number of persons in the bargaining unit proposed in paragraph (a).

• 4. 

  Where a proposed bargaining unit described by the applicant or by the employer under paragraph 3(a) consists in whole or in part of employees for whom no employee organization is certified as the bargaining agent, indicate which, if any, of those employees you claim should be excluded from the proposed bargaining unit because you consider them to be persons employed in a managerial or confidential capacity.
• 5. 

  Other matters considered relevant.

Dated at , this day of , 20, and signed on behalf of the employer by

(Signature)

Before the Public Service Labour Relations Board

(If necessary, attach additional pages of same size of paper)

• 1. 

  Applicant, name:

Employer, name:

Intervener, name and address:

• 2. 

  The intervener claims to represent .......

(Number)

employees in the bargaining unit described in the application.

• 3. 

  The intervener intends to make the following submission at any hearing that may be directed to be held by the Board in the proceeding:

Dated at , this day of , 20, and signed on behalf of the intervener by

(Signature)

(Office held in employee organization)

Before the Public Service Labour Relations Board

(If necessary, attach additional pages of same size of paper)

• 1. 

  Applicant, name:

Employer, name:

Intervener, name and address:

• 2. 

  Where the intervener is a council of employee organizations, state the name and address of each constituent employee organization.
• 3.

  (a) Detailed description of the unit of employees of the employer that the intervener proposes as appropriate for collective bargaining.

• (b) Estimate the number of employees within the proposed bargaining unit referred to in paragraph (a).

• 4. 

  (If you propose a bargaining unit different from the bargaining unit proposed by the applicant) The grounds on which you intend to rely to show that the bargaining unit described in the application of the applicant is not appropriate or that the bargaining unit you propose is more appropriate than the bargaining unit proposed by the applicant.
• 5. 

  Other matters considered relevant in support of this application:

Dated at , this day of , 20, and signed on behalf of the intervener.

(Signature)

(Office held in employee organization)

I declare that the answers and information contained in the foregoing intervener’s application are true in substance and in fact. I further declare that I have been duly authorized to make this intervener’s application. And I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath, and by virtue of the Canada Evidence Act.

Declared by the said

before me at , in the County of , in the Province of , this day of , 20

(Signature)

a Commissioner, etc

(To be declared before a Commissioner for taking affidavits or any other person authorized by law to administer an oath.)

Before the Public Service Labour Relations Board

(If necessary, attach additional pages of same size of paper)

• 1. 

  Applicant, name and address:

Bargaining agent, name and address:

• Footnote ^*2. 

  Employer, name and address:
• 3.

  (a) Description of the unit of employees for which the bargaining agent was certified:

• (b) Approximate number of employees in the bargaining unit described in paragraph (a):

• 4. 

  The section of the Parliamentary Employment and Staff Relations Act under which the applicant claims the certification of the bargaining agent should be revoked:
• 5. 

  (Where application is made under section 30, 31 or 32 of the Act) A summary of the grounds on which the applicant intends to rely in support of the applicant’s claim that the certification of the bargaining agent should be revoked giving sufficient particulars to enable the bargaining agent to know the case it will be called upon to meet:

Dated at , this day of , 20

• Return to footnote ^*Strike out if applicant is employer

(Signature)

I declare that the answers and information contained in the foregoing application are true in substance and in fact. And I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath, and by virtue of the Canada Evidence Act.

Declared by the said .......

before me at , in the County of , in the Province of , this day of , 20

(Signature)

a Commissioner, etc

(To be declared before a Commissioner for taking affidavits or any other person authorized by law to administer an oath.)

Before the Public Service Labour Relations Board

• 1. 

  Applicant, name and address:

Bargaining agent, name and address:

Employer, name and address:

• 2. 

  TAKE NOTICE that the applicant, on , 20, made an application to the Public Service Labour Relations Board for revocation of the certification of .......

(name of bargaining agent)

as bargaining agent of the employees of the employer in the following bargaining unit:

• 3. 

  Your attention is directed to the following information contained in the application:
• 4. 

  The terminal date for the application is the day of , 20
• 5. 

  Any employee or group of employees affected by the application who wishes to make representations to the Board in opposition to this application is required to file with the Board in writing a concise statement of opposition which statement shall

• (a) be signed by the employee or each member of the group of employees;

• (b) be accompanied by a return mailing address of the employee or representative of the group of employees; and

• (c) be filed not later than the terminal date (see Note below).

• 6. 

  The Board will accept only written statements that comply with the requirements set forth in section 5.
• 7. 

  Any employee or group of employees who has filed a written statement with the Board in accordance with section 5 shall be notified of any hearing that the Board may direct in the matter. Any person so notified may attend and be heard in person or may authorize a representative to appear in his place. The Board may dispose of the application without further notice where a party who has been notified of the hearing fails to attend.
• 8. 

  (Where the application is made under section 29 of the Act) No oral evidence of opposition to the application of the applicant will be accepted by the Board except to identify and substantiate the written statement of opposition.

Dated at , this day of , 20

Executive Director

Before the Public Service Labour Relations Board

(If necessary, attach additional pages of same size of paper)

• 1. 

  Applicant, name:
• 2. 

  Bargaining agent, name and address:
• 3. 

  Employer, name and address:
• 4. 

  Estimate the total number of employees in the bargaining unit described in the application.
• 5. 

  State the date of certification of the bargaining agent for the bargaining unit described in the application.
• 6. 

  Enclose a copy of any collective agreement or arbitral award affecting the employees in the bargaining unit.
• 7. 

  Other matters considered relevant.

Dated at , this day of , 20

Footnote ^*(Signature for bargaining agent)

Footnote ^*(Signature for employer)

• Return to footnote ^*Strike out words not applicable

Before the Public Service Labour Relations Board

(If necessary, attach additional pages of same size of paper)

• 1. 

  Name and address of party requesting arbitration:
• 2. 

  Name and address of the other party to the dispute:
• 3. 

  The bargaining unit in respect of which the request is made:
• 4. 

  The date on which notice to commence bargaining collectively was given under section 37 of the Act:
• 5. 

  Describe the steps that have been taken, including the dates of meetings that have been held, and the progress that has been made in collective bargaining following the giving of notice to commence bargaining:
• 6. 

  Specify the terms and conditions of employment in respect of which arbitration is requested:
• 7. 

  State your proposals concerning the award to be made by the Board with respect to the terms and conditions of employment specified in section 6:
• 8. 

  Annex a copy of any collective agreement entered into by the parties.

Dated at , this day of , 20

(Signature)

Before the Public Service Labour Relations Board

(If necessary, attach additional pages of same size of paper)

• 1. 

  Name of the party requesting arbitration:
• 2. 

  Name of the other party to the dispute:
• 3. 

  The bargaining unit in respect of which the request is made:
• 4. 

  Specify the terms and conditions of employment additional to those specified in Form 12, in respect of which arbitration is requested:
• 5. 

  State your proposals concerning the award to be made by the Board with respect to the additional terms and conditions of employment specified in section 4:
• 6. 

  State your proposals concerning the award to be made by the Board with respect to the terms and conditions of employment specified in section 6 of Form 12:

Dated at , this day of , 20

(Signature)

Before the Public Service Labour Relations Board

PART I — TO BE COMPLETED IN ALL CASES

I, the undersigned, hereby refer a grievance to adjudication under section 63 of the Parliamentary Employment and Staff Relations Act. The particulars are as follows:

1.	LAST OR FAMILY NAME	2.	FIRST AND OTHER NAMES
	(print in block letters)		(underline name used)
	Mr.
	Mrs.
	Miss
	Ms.
3.	HOME ADDRESS	4.	HOME PHONE NO.
	(no., street, city, province)
5.	EMPLOYER	6.	LOCATION
7.	BRANCH OR DIVISION	8.	SECTION OR UNIT
9.	JOB TITLE	10.	JOB CLASSIFICATION
11.	(a) Exact date on which the grievance was presented at the first level of the grievance process:	12.	Exact date on which the employer served on you a reply, if any, at the final level of the grievance process:
	(b) Exact date on which the grievance was presented at the final level of the grievance process:
BE SURE TO ATTACH A COPY OF THE ORIGINAL GRIEVANCE
PART II	To be completed ONLY if the grievance does not relate to the interpretation or application of a collective agreement or arbitral award. Indicate below applicable paragraph of subsection 63(1) of the Act under which the grievance is being referred to adjudication.
	.......63(1)(b)	disciplinary action resulting in suspension or a financial penalty
	.......63(1)(c)	termination of employment
	.......63(1)(d)	demotion
	.......63(1)(e)	denial of appointment
	.......63(1)(f)	classification
NOTE:	You do not require the approval or support of your bargaining agent, if any. You may be represented by your bargaining agent or, if you have no bargaining agent, by any employee organization willing to represent you, or by counsel or other person, or you may represent yourself.
13. NAME, ADDRESS AND PHONE NUMBER OF YOUR REPRESENTATIVE, IF ANY:
Dated at , this day of , 20
(Signature of aggrieved employee)
PART III	To be completed ONLY if the grievance relates to the interpretation or application of a collective agreement or arbitral award.
NOTE:	A grievance relating to the interpretation or application of a collective agreement or arbitral award may not be referred to adjudication without the approval and representation of your bargaining agent.
14. NAME OF BARGAINING AGENT:
Dated at , this day of , 20
(Signature of aggrieved employee)
APPROVAL OF BARGAINING AGENT (TO BE COMPLETED BY AUTHORIZED REPRESENTATIVE OF BARGAINING AGENT)
15.        (a)	The parties to the collective agreement or arbitral award are:
(b)	The name of the bargaining unit or group in respect of which the collective agreement or arbitral award was made is:
(c)	The duration of the collective agreement or arbitral award is from to
(d)	The aggrieved employee relies on the following clause(s) of the collective agreement or arbitral award:
(e)	Name and address of adjudicator, if any, named in collective agreement:
ON BEHALF OF THE BARGAINING AGENT, I APPROVE OF THE REFERENCE OF THIS GRIEVANCE TO ADJUDICATION AND STATE THAT THE BARGAINING AGENT IS WILLING TO REPRESENT THE EMPLOYEE IN THE ADJUDICATION PROCEEDINGS
DATE
(Signature of authorized representative of bargaining agent)
(Office held by authorized representative  of bargaining agent)

PART IV ESTABLISHMENT OF A BOARD OF ADJUDICATION

The Act provides that a “board of adjudication” may be established, at the expense of the parties, only if the employee so requests and if the employer has no objection. This is the effect of certain provisions in section 65, 66 and 69 of the Act.
NOTE:	If you request that a “board of adjudication” be established, please state the name and address of your nominee (provided that he has no direct interest in the grievance and provided also that he is willing to serve) and sign below.
	NAME, ADDRESS AND PHONE NUMBER OF YOUR NOMINEE:
Dated at , this day of , 20
(Signature of aggrieved employee)

• TO: 

  Name of Employer
• 1. 

  TAKE NOTICE THAT has requested that a board of adjudication be established for the grievance referred to adjudication on the day of , 20
• 2. 

  AND FURTHER TAKE NOTICE that you are required to file with the Executive Director, not later than the 10th day after the service of this notice on you

• (a) the name of the person you wish to nominate to be a member of the board of adjudication; or

• (b) your objection to the appointment of a board of adjudication

Dated at , this day of , 20

Executive Director

• 1. 

  TAKE NOTICE that the hearing on the reference to adjudication filed by on will be held on the day of , 20 at o’clock in the noon, at .......
• 2. 

  AND FURTHER TAKE NOTICE that if you fail to attend at the hearing, the adjudicator may proceed in your absence and dispose of the grievance without further notice to you.

Dated at , this day of , 20

Executive Director

Before the Public Service Labour Relations Board

(If necessary, attach additional pages of same size of paper)

• 1. 

  Bargaining agent, name and address:

Employer, name and address:

• 2. 

  The employer and the bargaining agent

• Footnote ^*(a) have executed the collective agreement

• Footnote ^*(b) are bound by the arbitral award

a copy of which is attached to this reference.

• Return to footnote ^*Strike out words not applicable.

• 3. 

  The Footnote ^*employerseeks to enforce the following

Footnote ^*bargaining agent

obligation that is alleged to arise out of the

Footnote ^*collective agreement:

Footnote ^*arbitral award:

• Return to footnote ^*Strike out words not applicable.

.......

(state nature of obligation and include a reference to the relevant articles of the collective agreement or arbitral award)

.......

• 4. 

  It is alleged that there has been a failure to observe or to carry out the said obligation, the particulars of which are as follows:

.......

(state particulars, including dates of the acts or omissions which are alleged to be contrary to the said obligation)

Dated at , this day of , 20

(Signature)

Before the Public Service Labour Relations Board

(If necessary, attach additional pages of same size of paper)

• 1. 

  Applicant, name and address:

Respondent, name and address:

• 2. 

  Describe the nature of the offence alleged or the prohibition alleged not to have been observed.
• 3. 

  Indicate the section of the Act alleged to have been contravened.
• 4. 

  Provide a summary of the material facts on which the applicant intends to rely to support this application.

Dated at , this day of , 20 and signed on behalf of the applicant by

(Signature)

Before the Public Service Labour Relations Board

• 1. 

  Applicant, name and address:

Respondent, name and address:

• TO: (name of individual respondent)

• 2. 

  TAKE NOTICE that the applicant, on the day of , 20, made to the Board an application, a copy of which is attached.
• 3. 

  AND FURTHER TAKE NOTICE that the statutory declaration or the statement made under oath or affirmation attached hereto has been filed by the applicant in support of the application for consent to institute prosecution against you for an alleged violation of of the Parliamentary Employment and Staff Relations Act which reads as follows:
• 4. 

  AND FURTHER TAKE NOTICE that should you wish to reply to the application, either to rebut the specific allegations made by the applicant contained in the above mentioned documents with respect to you, or to make representations to the Board with respect to the application, other than to rebut the specific allegations, you are directed to do so in writing which is required to be received by the Board or, if sent by registered mail, mailed not later than the day of , 20
• 5. 

  AND FURTHER TAKE NOTICE that, on the expiration of the day set out in section 4, the Board may make its determination on the application on the basis of all the material then before it. If no reply is submitted by you on or before that day, the Board may make its determination on the application, in so far as it relates to you, on the basis of the material then before it.
• 6. 

  AND FURTHER TAKE NOTICE that should the Board grant leave to the applicant to institute a prosecution against you, and should you ultimately be found guilty as alleged, you would be subject to the provisions of of the Parliamentary Employment and Staff Relations Act which provide as follows:
• Footnote ^*NOTE: 

  You may wish to consult with the representative of your bargaining agent, (name of bargaining agent), before making a reply, but the time limit set out in section 4 above must be observed.

Dated at , this day of , 20

Executive Director

• Return to footnote ^*Strike out if not applicable.