Pay Equity Commission 180 Dundas St W Suite 300 Toronto On M7A 2S6 416 314-1896 or 1 800 387-8813 TTY 416 212-3991 or 1 855 253-8333 Fax 416 314-8741
File No.
Note: Please answer all questions within the application form and submit by mail or in person. Please type or print clearly in ink. You may add additional pages if space is insufficient.
Submit this application to the following address: Pay Equity Commission Pay Equity Office 180 Dundas St W Suite 300 Toronto On M7A 2S6 416 314-1896 or 1 800 387-8813 TTY: 416 212-3991 or 1 855 253-8333 Fax: 416 314-8741
Last Name First Name
Current Employee Former Employee Employment Start Date (yyyy/mm/dd)
Job 1. Title 1. Start Date (yyyy/mm/dd) 1. End Date (yyyy/mm/dd)
Job 2. Title 2. Start Date (yyyy/mm/dd) 2. End Date (yyyy/mm/dd)
Job 3. Title 3. Start Date (yyyy/mm/dd) 3. End Date (yyyy/mm/dd)
Yes (if you have a copy of the plan, please forward it to us) No I do not know
Yes No I do not know
7. Why do you think that pay equity is not being maintained in the organization?
8. If you believe that there are significant changed duties and responsibilities for your job class that would result in changes to the pay equity plan or the male comparator, please provide specific details as to what those changed duties and responsibilities are and indicate when you believe the changes occurred? If you were in different female job classes, identify the changes for each job class and the time that they occurred. For example, if you believe there were significant increases in the tasks assigned to your job class and increased responsibilities please list the changed and new tasks and explain what additional/new tasks and responsibilities were assigned to you.
Yes (If so, when did this occur? yyyy/mm/dd) No I do not know
Yes, I did raise this concern with my Employer (If so, when did this occur? yyyy/mm/dd) No, I did not raise this concern with my Employer. Employer response
Yes (If so, when did this occur? yyyy/mm/dd) No
Individual Committee Last Name First Name
13.If there was a review but you disagree with the explanation and or results, please indicate why.
15. Are you aware of generally what process, if any, exists in your workplace if there are changed or new jobs? For example, are there any individuals or departments responsible for dealing with job descriptions for new and or existing jobs? If so, please explain.
17.If your female job class(es) has been compared to a male job class that has received increased compensation and/or benefits, but your job class has not, please provide details.
Yes, additional compensation or benefits were provided (If so, when did this occur? yyyy/mm/dd) No, Additional compensation or benefits were not provided. Description of additional compensation or benefits provided
20. Provide copies of any correspondence or documents, if any, relating to these issues. For example, this could include any job descriptions, memos, letters, newsletters, or other documents. The information is collected under the authority of the Pay Equity Act, 1987 for the purposes of its enforcement.
For information concerning the collection and use of this information, please contact Legal Counsel, Pay Equity Office, at the following address:
Pay Equity Commission Pay Equity Office 180 Dundas St W Suite 300 Toronto On M7A 2S6 416 314-1896 or 1 800 387-8813 TTY: 416 212-3991 or 1 855 253-8333 Fax: 416 314-8741
I certify that the information provided is true and correct to the best of my knowledge. Last Name of person completing this form First Name of person completing this form