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Yes
No

An employee
An employer
A union official or representive

Yes
No

Union Representative Details


Applicant Personal Details



Alternate contact details of employee: (Neighbour/Friend/Colleague)



Yes
No

Details of the other Party


Yes
No


Nature of the Dispute


Please specify nature of dispute:




The applicable circular, bulletin or gazette
The post description.
The post numbers.
Yes
No




Relief Sought



Special Features / Additional Information



Do you require an interpreter?
Yes
No
Choose a language:
Briefly outline any special features that the ELRC needs to note
Add your Signature for Form E1

Informing the other Party


I confirm that a copy of this form has been sent to the other party/parties to the dispute and proof of this is attached to this form.

Commencement of Employment



Notice of Dismissal


How were you informed of your dismissal?
Yes
No

Disciplinary Hearing


Yes
No

Reasons for Dismissal


Please provide a reason:

Fairness/Unfairness of Dismissal




Do you think that the dismissal was procedurally unfair? (Were internal procedures followed?)
Yes
No


Do you feel the reason for the dismissal was substantively unfair?
Yes
No

Collective Agreement


ELRC Collective Agreement
PSCBC


Form E2


Affidavit


The dispute arose on after all attempts to negotiate or follow internal procedures of the Respondent failed.
The referral is days late
I did the following to pursue my rights after the dispute arose: *
I signed the referral form on
The reason/s that I referred the matter late is: *
I believe that I have good prospects of success because (explain with good reasons why you believe that you have a strong case): *
As the Applicant (employee), if condonation is not granted, I will be prejudiced because: *
I believe that the Respondent (employer party) will / will not be prejudiced if condonation is granted because: *
Any other relevant information: I humbly pray that the application for condonation be granted.
Add your Signaute for Form E2

POPIA CONFIRMATION


By submitting this document, I/we hereby grant my/our voluntary consent that my/our personal information may be processed, collected, used and disclosed in compliance with the Protection of Personal Information Act, 4 of 2013. I/We furthermore agree that my/our personal information may be used for the lawful and reasonable purposes in as far as the ELRC (responsible party) must use my/our information in the performance of its public legal duty. I/We understand that my/our personal information may be disclosed to a third party in as far as the ELRC must perform its public legal duty. I/We further understand that there are instances in terms of the abovementioned Act where my express consent is not necessary to permit the processing of personal information, which may be related to litigation or when the information is publicly available.