Seniority List Dispute Form

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					                    Seniority List Dispute Form, Unit A
               Professional Student Services Personnel
                           434 Rogers Rd Tel: 647/348-3351 Fax: 647-348-3352

 Fill out this form and submit by fax or email to by October 24, 2011 if you
 disagree with the information listed on the TDSB Unit A September 2011 seniority list.

First Name:______________________            Last Name: ______________________________________

Home address: _______________________________City:________________P/Code:____________

Work phone: ______________________________                Email: ________________________________

Home/Cell phone: _________________________                 Employee #: ___________________________

Worksite: __________________________________________________________________________

 The error on the seniority list is:(Please check all that apply) ________ date _______ my name is not on the list

 _____ a spelling error ______ an information error     __________name is on wrong list – it should appear on

 Seniority date given by TDSB:      ____/____/______

 Do you agree with this date? _________ Yes           __________________ No

 If “no”, what date should be your seniority date:           _______/_______/_________

 Did you previously dispute your seniority date? __________ Yes ____________ No

 Please name any other errors/issues: _____________________________________________________

 The correct information should be: _______________________________________________________

                                                 Work History
Please list your date of permanent employment with the TDSB: ___________________________________

Please list any employment with TDSB previous to the date above: _________________________________


Date submitted: _________________________

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