The personal information on this form is collected under authority of the Municipal Act 2001, SO 2001, c.25 and will be used only to administer the Employee Discount Transit Program Termination. Questions about the collection of this personal information should be directed to: Transportation ProjectsOffice, 800 – 201 City Centre Drive, 905-615-3200 ext. 5384
Employee Details
First Name / Last Name
Employee Number / Department ______Community ServicesCorporate ServicesCity Manager's OfficeMayor and Councillor's OfficesPlanning and BuildingTransportation and Works
Division: / Building (work location) Floor
Terms of Agreement
I request to terminate my participation in the Discount Transit Program as of the month of ______JanuaryFebruaryMarch April May JuneJulyAugustSeptemberOctoberNovemberDecember in the year______20102011. I understand that by deciding to terminate my participation in the program, I will not be allowed to rejoin the program for a period of two (2) months following such termination. I understand that in order to terminate my participation in the program, I must submit this form to the Transportation ProjectsOffice prior to the postedmonthly cut-off date for termination in the program (listed on the reverse of this form) in order to process the termination of pass orders and payroll deductions. I understand that passes are non-refundable. Terminations received after the cut-off dates listed on the reverse of this form will be processed for the following month.
Agreement
I have read, understand and agree tothe Terms of Agreement as listed above and direct the City to terminate my participation in the Smart Commute Employee Discount Transit Program in accordance with the terms above. This shall constitute my direction and provide the City with full and sufficient authority of the City to stop the aforementioned deductions above as authorized by the Employment Standards Act, S.O. 2000, c.41, s.13 (3), and the Regulations passed pursuant thereto or any other applicable legislation.
Employee’s signature (handwritten) ______Date (YYYY/MM/DD):
Feedback on the Discount Transit Program
During the months that you purchased transit passes through this program, how often did you use public transit to commute to work? (check one)
Every day Most days Occasionally Very Rarely Never
Overall, how would you rate the Discount Transit Program? (check one)
Excellent Very Good Good Fair Poor Very Poor
How would you rate the ease of registration? (check one)
Excellent Very Good Good Fair Poor Very Poor
How would you rate the convenience of purchasing monthly passes through this program? (check one)
Excellent Very Good Good Fair Poor Very Poor
How would you rate the timeliness of pass delivery? (check one)
Excellent Very Good Good Fair Poor Very Poor
Please indicate how strongly you agree or disagree with the following statement:
I feel that payments for transit passes were deducted from my pay in a reasonable and timely manner. (check one)
Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
Please tell us why you decided to opt-out of the Discount Transit Program? (choose all that apply)
Work / Life Change. Please choose from drop down menu: ______Moved out of MississaugaRequire a car for workChanged jobsOther life change
Cost. Please choose from drop down menu: ______Pass is too expensivePass doesn't offer enough value for the costLess expensive for me to use tickets / weekly pass
Time / Convenience. Please choose from drop down menu:______Service was not frequent enoughBus trips were too longToo many transfers between buses were requiredToo many service delaysToo far to walk to bus stops (from home or work)Difficulty finding route and schedule information
Comfort. Please choose from drop down menu: ______Uncomfortable taking transit in poor weatherLack of seating on busesLack of bus sheltersBuses were not clean insidePrefer the privacy of car travel
Other. Please specify (maximum 140 characters):
Would you recommend the program to a friend?
Definitely Probably Might / Might Not Probably Not Definitely Not
Other comments, if any(maximum 140 characters):
Form Submission – Fill out electronically, print, save a copy for your records.
Submit hard copy via internal mail to Active Transportation Office, 201 City Centre Drive, Suite 800
See below for important termination information
Termination
If employees decide to terminate their participation in the program, they will not be allowed to rejoin the program for a period of two (2) months. To terminate participation, employees must submit an “Employee DTP - Termination Form” to the City’s Transportation Projects Office, 201 City Centre Drive, Suite 800 prior to the posted monthly cut-off date for termination listed below in order to process the termination of participation. Terminations received after the cut-off dates listed below will be processed for the following month.
Discount Transit Program Schedule
Pass Valid Date / Employee Registration & Termination Cut-Off / Proof of Payment Submission Deadline / Payroll ReimbursementMay 1, 2016 / May 1, 2016 / May 15, 2016 / June 9, 2016
June 1, 2016 / June 1, 2016 / June 15, 2015 / July 7, 2016
July 1, 2016 / July 1, 2016 / July 15, 2016 / August 4, 2016
Aug 1, 2016 / Aug 1, 2016 / August 15, 2016 / September 15, 2016
September 1, 2016 / September 1, 2016 / September 15, 2016 / October 13, 2016
October 1, 2016 / October 1, 2016 / October 15, 2016 / November 10, 2016
November 1, 2016 / November 1, 2016 / November 15, 2016 / December 8, 2016
December 1, 2016 / December 1, 2016 / December 15, 2016 / January 19, 2017
January 1, 2017 / January 1, 2017 / January 15, 2017 / February 16, 2017
February 1, 2017 / February 1, 2017 / February 15, 2017 / March 16, 2017
March 1, 2017 / March 1, 2017 / March 15, 2017 / April 13, 2017
April 1, 2017 / April 1, 2017 / April 15, 2017 / May 11, 2017
May 1, 2017 / May 1, 2017 / May 15, 2017 / June 8, 2017
June 1, 2017 / June 1, 2017 / June 15, 2017 / July 6, 2017
July 1, 2017 / July 1, 2017 / July 15, 2017 / August 17, 2017