Intake Form | AJC

To be completed by all AJC members requesting assistance

This form is to be used for any questions or representation requests to the AJC. In order to serve you better, we ask that you first consult our FAQs and then your regional Governing Council representative, where applicable, before completing and forwarding an intake form to the AJC. Thank you.

Are you a Registered Member of the AJC? If not, you must complete and submit a membership form prior to receiving assistance from the AJC.

Respect: Crown Counsel deserve it, as do the AJC representatives who are here to assist them. Please help us ensure that AJC staff and its representatives work in a safe and healthy environment. We will not tolerate any verbal abuse, aggressive or violent behaviour towards our staff.

SECTION 1 – Personal Information

Name of Member *

Department/Agency *

Place of Work *

Classification

Position Title

Position Number

(if known)

Personal Email Address *

Work Address

Home Address

Work Phone

Home Phone

SECTION 2 – Intake Summary

Month

Day

Year

Date of occurrence giving rise to your request

(if applicable)

Name(s) of Management Involved:

Details *

(description of issue and questions):

SECTION 3 – Actions

Actions Taken to Date

Remedial Actions Sought

(if applicable)