Forms

Grievance Forms

Policy Grievance Form

Return to Work and Accommodation

physicians-statement-blank

Long Term Disability

For procedures please see the Long Term Disability Committee page.

Standard Life Disability Claim Form (no longer current provider)

Manulife Disability Claim Form (full form, fillable)

SECTIONS (NOT CURRENT AS OF OCT.27th, 2016)

  • Participant’s Statement (pages 2-4)
  • HR Statement (page 5)
  • Supervisor’s Statement (page 6)
  • Physician’s Statement – Physical Conditions (pages 7-8)
  • Physician’s Statement – Psychological Conditions (pages 9-10)

Employees seeking Union Leave must complete the Request for Union Leave Form, and approval must be provided at the supervisory and Union Executive level. For more information on the types of Union Leave associated with this form, please see “Guideline – Union Representation in the Workplace” on the Hub.

Employee Requesting Leave

Employee requesting Union Leave completes the following fields:

  • Employee name
  • Classification
  • Worksite
  • Status (full-time, part-time, or auxiliary)
  • Date(s) of requested leave
  • Hours

Employee emails* the form to their supervisor for review.

Supervisor

If approved, the supervisor types their name into the Supervisor field and emails* the form to info@cupe391.ca.

Union Representative

If approved, the Union representative types their name into the Union President or Designate field and emails* it to Michael.woodhouse@vpl.ca and Katherine.chan@vpl.ca for processing.

Note: if relevant, comments may be added to “comment” field. Eg. if the employee is acting as Union President or providing Admin Support and should be paid at a rate other than their base rate, please provide this information in the comments field.

AUX/RPT Staff Without Pre-Booked Shift Taking Union Leave

Auxiliary and RPT employees who do not have a pre-booked shift may still take Union leave. In that case, a Union Representative will email the Payroll and Benefits Administrator with the details of the leave (name of employee; date of leave; number of hours), and then follow up by completing and emailing the Request for Union Leave Form as per the above process.

*How to email the form as an attachment

MS Outlook – client (“full” desktop edition): simply click on the “email” button on the top of the form and then select “Default email application (Microsoft Outlook)”.

Web (browser-based) edition: you will need to attach the document manually. Click “File” => “Save as” and save the document to your computer. Then open a new email message and attach the Form to your email.

Scholarship – CUPE 391 / VPL library studies scholarship

Self-Funded Leave

Others

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