To be completed by all AJC members requesting assistance This form is to be used for any questions or representation requests to the AJC. In order to serve you better, we ask that you first consult our FAQs and then your regional Governing Council representative, where applicable, before completing and forwarding an intake form to the AJC. Thank you. Are you a Registered Member of the AJC? If not, you must complete and submit a membership form prior to receiving assistance from the AJC. Respect – Like our members, AJC staff must work in a safe and healthy environment. Verbal abuse and aggressive or violent behaviour towards staff will not be tolerated. Is your inquiry an urgent matter that may need a rapid response from our Representation Team? * No Yes Urgent Matter * Urgent matters may include, for example, imminent investigation or fact-finding meetings with the employer, termination on probation, pay issues requiring immediate assistance due to hardship, or an upcoming grievance deadline etc. Please note that if we determine that your inquiry is not of an urgent nature, you will receive a response within our normal timeframe. Please note that completing this intake form does not represent filing a grievance. The process to file a grievance is set out in the AJC Policy Governing Representation Services. The deadline to file a grievance is 25 workings days from the date of the breach or the date on which you first became aware of a breach. It is your responsibility to track and meet this deadline, which excludes weekends and designated holidays. SECTION – URGENT MATTER Indicate reason(s) for needing a rapid response MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20222023202420252026 Year Response required by SECTION – References Have you consulted our FAQs? No Yes Have you consulted our FAQs? Have you contacted a Governing Council Representative? No Yes Have you contacted a Governing Council Representative? Who did you contact? SECTION 1 – Personal Information Name of Member * Department/Agency * Place of Work * Classification Position Title Position Number (if known) Personal Email Address * Work Address Home Address Work Phone Home Phone SECTION 2 – Intake Summary MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20222023202420252026 Year Date of occurrence giving rise to your request (if applicable) Name(s) of Management Involved: Details * (description of issue and questions): SECTION 3 – Actions Actions Taken to Date Remedial Actions Sought (if applicable) CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit
