Use this form to keep your Union System office informed of changes to your employment status! If you go on furlough, take a medical leave of absence, go on military leave, or similar, the railroads may not inform or update us on your status until well after the fact, creating issues with your pay, benefits, and dues. We can assist you in ensuring all these matters are taken care of, but you have to let us know what's going on with you!

Please keep in mind, we don't need you to prove or document your status change. At the Union office, we don't need medical forms, leave information, or anything like that (your employer policy may differ). This is simply to help track changes in your status so we can better assist you with changes to your dues, if necessary, and support any other issues you may have.

*First name:
*Last Name:
*Employee Number:
*Email Address:
Address:
Phone Number:
Cell Phone Service Provider:
*My Status is Changing to:
----- If Other, please specify:
*What is the date this change will take effect (Ex: Last Day Worked, Day reported to new assignment)?:
What is your expected or estimated Return to Work Date?
* Indicates a Required Field