Contact Information | Informations de contact
Signing up is anonymous and confidential. Information collected on this form will be used for adding representative plaintiffs, administering the claim, and to determine how many Blacks are employed in the Federal Public Service. If you have any questions please email
info@blackclassaction.ca
| L'inscription est anonyme et confidentielle. Les informations recueillies sur ce formulaire seront utilisées pour ajouter des représentants des plaignants, administrer la réclamation et déterminer combien de Noirs sont employés dans la fonction publique fédérale. Si vous avez des questions, veuillez envoyer un courriel à
info@blackclassaction.ca
* Required
I certify that I self-identify as Black (Caribbean or African descent) | Je certifie que je m'identifie comme Noir (descendance caribéenne ou africaine)
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Eligibility: potential class members must self-identify as Black, Caribbean or African descendant. Do not complete this form if you do not meet this criteria. | Admissibilité: les membres potentiels du cours doivent s'identifier comme descendant noir, caribéen ou africain. Ne remplissez pas ce formulaire si vous ne répondez pas à ces critères.
Yes
Required
Legal Name | Nom légal
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First and last name | Prénom et nom
Your answer
Mailing Address | Adresse postale
*
Your answer
Phone number | Numéro de téléphone
*
Please provide your non-work phone number | Veuillez fournir votre téléphone personnel
Your answer
Email Address | Adresse e-mail
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Please provide your home email address. Updates about the claim will be provided to this email address | Veuillez fournir votre adresse e-mail personnelle. Les mises à jour concernant la réclamation seront fournies à cette adresse e-mail.
Your answer
Work Information | Renseignements sur l'employeur
What is the name of your federal employer? | Quel est le nom de votre employeur fédéral?
*
Choose
Accessibility Standards Canada
Administrative Tribunals Support Service of Canada
Agriculture and Agri-Food Canada
Atlantic Canada Opportunities Agency
Atlantic Pilotage Authority Canada
Atomic Energy of Canada Limited
Auditor General of Canada
Bank of Canada
Bank of Canada Museum
Blue Water Bridge Canada
Business Development Bank of Canada
Canada Agricultural Review Tribunal
Canada Agriculture and Food Museum
Canada Aviation and Space Museum
Canada Border Services Agency
Canada Council for the Arts
Canada Deposit Insurance Corporation
Canada Development Investment Corporation
Canada Economic Development for Quebec Regions
Canada Employment Insurance Commission
Canada Energy Regulator
Canada Firearms Centre
Canada Industrial Relations Board
Canada Infrastructure Bank
Canada Lands Company Limited
Canada Mortgage and Housing Corporation
Canada Pension Plan Investment Board
Canada Post
Canada Research Chairs
Canada Revenue Agency
Canada School of Public Service
Canada Science and Technology Museum
Canadian Air Transport Security Authority
Canadian Army
Canadian Centre for Occupational Health and Safety
Canadian Coast Guard
Canadian Commercial Corporation
Canadian Conservation Institute
Canadian Cultural Property Export Review Board
Canadian Dairy Commission
Canadian Food Inspection Agency
Canadian Grain Commission
Canadian Heritage
Canadian Heritage Information Network
Canadian Human Rights Commission
Canadian Institutes of Health Research
Canadian Intellectual Property Office
Canadian Intergovernmental Conference Secretariat
Canadian International Trade Tribunal
Canadian Judicial Council
Canadian Museum for Human Rights
Canadian Museum of History
Canadian Museum of Immigration at Pier 21
Canadian Museum of Nature
Canadian Northern Economic Development Agency
Canadian Nuclear Safety Commission
Canadian Pari-Mutuel Agency
Canadian Police College
Canadian Race Relations Foundation
Canadian Radio-Television and Telecommunications Commission
Canadian Security Intelligence Service
Canadian Space Agency
Canadian Special Operations Forces Command
Canadian Trade Commissioner Service
Canadian Transportation Agency
Canadian War Museum
CBC/Radio-Canada
Civilian Review and Complaints Commission for the RCMP
Commissioner for Federal Judicial Affairs Canada
Commissioner of Lobbying of Canada
Communications Research Centre Canada
Communications Security Establishment Canada
Competition Bureau Canada
Competition Tribunal
Conflict of Interest and Ethics Commissioner
Copyright Board Canada
CORCAN
Correctional Investigator Canada
Correctional Service Canada
Court Martial Appeal Court of Canada
Courts Administration Service
Crown-Indigenous Relations and Northern Affairs Canada
Defence Construction Canada
Defence Research and Development Canada
Democratic Institutions
Destination Canada
Elections Canada
Employment and Social Development Canada
Environment and Climate Change Canada
Environmental Protection Review Canada
Export Development Canada
Farm Credit Canada
Farm Products Council of Canada
Federal Bridge Corporation
Federal Court of Appeal
Federal Court of Canada
Federal Economic Development Agency for Southern Ontario
Federal Ombudsman for Victims Of Crime (Office of the)
Finance Canada (Department of)
Financial Consumer Agency of Canada
Financial Transactions and Reports Analysis Centre of Canada
Fisheries and Oceans Canada
Freshwater Fish Marketing Corporation
Global Affairs Canada
Governor General of Canada
Great Lakes Pilotage Authority Canada
Health Canada
Historic Sites and Monuments Board of Canada
Human Rights Tribunal of Canada
Immigration and Refugee Board of Canada
Immigration, Refugees and Citizenship Canada
Impact Assessment Agency of Canada
Independent Review Panel for Defence Acquisition
Indian Oil and Gas Canada
Indigenous and Northern Affairs Canada
Indigenous Services Canada
Industrial Technologies Office
Information Commissioner (Office of the)
Infrastructure Canada
Innovation, Science and Economic Development Canada
Intelligence Commissioner (Office of the)
Intergovernmental Affairs
International Development Research Centre
Jacques Cartier and Champlain Bridges
Judicial Compensation and Benefits Commission
Justice Canada (Department of)
Labour Program
Laurentian Pilotage Authority Canada
Leader of the Government in the House of Commons
Library and Archives Canada
Marine Atlantic
Measurement Canada
Military Grievances External Review Committee
Military Police Complaints Commission of Canada
National Arts Centre
National Battlefields Commission
National Capital Commission
National Defence
National Film Board
National Gallery of Canada
National Research Council Canada
National Security and Intelligence Review Agency
National Seniors Council
Natural Resources Canada
Natural Sciences and Engineering Research Canada
Northern Pipeline Agency Canada
Occupational Health and Safety Tribunal Canada
Office of the Chief Military Judge
Office of the Commissioner of Official Languages
Ombudsman for the Department of National Defence and the Canadian Armed Forces (Office of the)
Pacific Pilotage Authority Canada
Parks Canada
Parliament of Canada
Parole Board of Canada
Patented Medicine Prices Review Board Canada
Polar Knowledge Canada
Prime Minister of Canada
Privacy Commissioner of Canada (Office of the)
Privy Council Office
Procurement Ombudsman (Office of the)
Public Health Agency of Canada
Public Prosecution Service of Canada
Public Safety Canada
Public Sector Integrity Commissioner of Canada (Office of the)
Public Sector Pension Investment Board
Public Servants Disclosure Protection Tribunal Canada
Public Service Commission of Canada
Public Service Labour Relations and Employment Board
Public Services and Procurement Canada
Registry of the Specific Claims Tribunal of Canada
Ridley Terminals Inc.
Royal Canadian Air Force
Royal Canadian Mint
Royal Canadian Mounted Police
Royal Canadian Mounted Police External Review Committee
Royal Canadian Navy
Royal Military College of Canada
Secretariat of the National Security and Intelligence Committee of Parliamentarians
Service Canada
Shared Services Canada
Social Sciences and Humanities Research Council of Canada
Social Security Tribunal of Canada
Standards Council of Canada
Statistics Canada
Superintendent of Bankruptcy Canada (Office of the)
Superintendent of Financial Institutions Canada (Office of the)
Supreme Court of Canada
Tax Court of Canada
Taxpayers' Ombudsman (Office of the)
Telefilm Canada
Translation Bureau
Transport Canada
Transportation Appeal Tribunal of Canada
Transportation Safety Board of Canada
Treasury Board of Canada Secretariat
Veterans Affairs Canada
Veterans Review and Appeal Board
Veterans' Ombudsman (Office of the)
VIA Rail Canada
Virtual Museum of Canada
Western Economic Diversification Canada
What is the date you were hired? | Quelle est la date de votre embauche?
*
MM
/
DD
/
YYYY
What is the date that your employment ended with the Federal Government? Quelle est la date à laquelle votre emploi a pris fin avec le gouvernement fédéral?
Optional if still employed with the Federal Government. | Facultatif si toujours employé avec le gouvernement fédéral.
MM
/
DD
/
YYYY
What was the reason your employment ended? | Quelle était la raison pour laquelle votre emploi a pris fin?
Retired | Retraitée
Resigned | Résigné
Terminated | Terminé
Other:
Clear selection
What is or was your job classification? | Quelle est ou était votre classification d'emploi?
*
Examples: AU-01, SP-04, PM-01
Your answer
How many promotions have you received since you joined the Federal Government? | Combien de promotions avez-vous reçues depuis votre arrivée au gouvernement fédéral?
None | Aucun
One | Un
Two | Deux
Three | Trois
Four | Quatre
Cinq ou plus
Clear selection
Describe the length of time of each promotion (if applicable). | Décrivez la durée de chaque promotion (le cas échéant).
Your answer
Do you have an ongoing grievance or Canadian Human Rights complaint? If so, please provide sufficient detail about the nature and timeline. | Avez-vous un grief en cours ou une plainte canadienne relative aux droits de la personne? Dans l'affirmative, veuillez fournir suffisamment de détails sur la nature et le calendrier.
Your answer
What is or was your experience as a Black individual working for the Federal Government, as it pertains to hiring and promotions? | Quelle est ou était votre expérience en tant que personne noire travaillant pour le gouvernement fédéral, en ce qui concerne l'embauche et les promotions?
*
Please provide a sufficient summary of your situation to help our legal team to assess eligibility.
Your answer
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