1

DATE, File No. INSERT

Employment Standards Branch Adjudication

APPLICANT: RESPONDENT:

Employee Name Employer Name

Enclosures

  1. Applicant’s Submission
  1. Documents

-List documents here

A. document

B. document

C. another document

Applicant’s Submission

This is an application by CLIENTNAME for compensation for unpaid termination pay, overtime pay, statutory holiday pay and vacation pay as required by the Employment Standards Act [RSBC 1996] Chapter 113 (the “Act”) (OR SPECIFY WHAT YOUR CLIENT IS SEEKING)

CLIENTNAME seeks a total of $AMOUNT from EMPLOYERNAME in the following amounts:

  1. Termination pay in the amount of INSERT IF APPLICABLE as required under section 63(1) of the Act. This amount was determined utilizing the formula in section 63(4) of the Act. OR DESCRIBE HOW YOU ARRIVED AT THIS AMOUNT
  1. Compensation for unpaid overtime wages in the amount of INSERT IF APPLICABLE as required by section 35 of the Act and calculated using the formula set out in section 40 of the Act.
  1. Compensation for unpaid statutory holiday pay in the amount of INSERT IF APPLICABLE as required by sections 44-46 of the Act
  1. Vacation pay in the amount of INSERT IF APPLICABLE AND HOW CALCULATED. It represents the statutory minimum for vacation pay as set out in section 58(1) of the Act.
  1. CLIENTNAME also seeks INSERT IF ANYTHING ELSE

A) Facts

  1. CLIENTNAME worked for EMPLOYER for a period of INSERT months beginning on INSERT and ending INSERT.
  1. CLIENTNAME was employed as a JOB TITLE. and provided on-site security monitoring at multiple worksites. CLIENTNAME’s duties included LIST DUTIES

Termination of Employment (include if applicable)

  1. CLIENTNAME was terminated by the employer INSERT DATE. The Record of Employment (ROE) notes that CLIENTNAME’s last day worked was INSERT
  1. Other facts pertaining to termination, including facts related to cause, if applicable

Overtime Wages and Statutory Holidays (include if applicable)

  1. Significant discrepancies exist between CLIENTNAME’s entitlement to overtime, and the actual amount of overtime pay that he has received. These discrepancies date all the way back to CLIENTNAME’s first month of employment, and continued to occur during nearly every pay period during his employment with EMPLOYER.

Other fact sections for your client’s situation

B) The Law

Here, set out the law, and explain how it applies to your client’s facts, and why they are entitled to what you are claiming. You can use the Act, Regulations, and case law as well as your client’s evidence. You can use the same subheadings as you used for “facts” above, or organize it in another logical way.

CONCLUSION

On the basis of the above, briefly reiterate what you are requesting.

Respectfully submitted,

______

YOURNAME

Law Student

______

Date