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Dated _________________
Covering: Entitlement to Pay Equity Agreement between
Public Service Alliance Canada and Treasury Board
Secretariat
I _________________________(full name) hereby attest that I
was employed with the Department of
________________________________ for the period (s) from
___________ and to ____________ as an _____________ (type of
employment) number of hours____________ per week in the
___________ (classification) group and level.
During the said period (s) of employment, I was away on leave
without pay for the following dates (state the dates and
time on leave without pay including strike pay, suspension, leave
without pay for other reasons).
or
During the said period (s) of employment I did not take any
leave without pay, was not suspended from pay and did not
strike.
Signature of former employee: __________________________
SWORN BEFORE ME at the City of _________________,
In the province of ________________, this ______ day
of ________________, 2001.
_________________________________________
Signature of Person authorized to Receive Oaths
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Title of Authorized Person .
Justice of the Peace, Commissioner, Notary etc.
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Stamp or authorization No.
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