For MERC Action

(to be used when an issue is not resolved at LERC table)

Ministry:

Local Number:

Workplace:

Please include the specific details about the issue.

Provide any documentation that may assist the discussion at your Ministry Employee Relations Committee (MERC).

Is the issue related to (please checkoff all that apply):

If you selected other, please identify:

Statement of the Issue:

The Resolution sought by your Local Employee Relations Committee (LERC):

Date Issue was declared unresolved by your LERC:

Is the Relevant material attached?

LERC Minutes dated:

Correspondence. Please list:

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone:

Work Phone:

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