Company Information
Company Name
(Required)
# of Employees
(Required)
Nature of Business
(Required)
Date
DD dash MM dash YYYY
Your Email Address
(Required)
Employee Information
List of Employees
(Required)
Employee Name
Occupation
Gender
Health Enrollment (S,C,F or W)
Dental Enrollment (S,C,F or W)
D.O.B. / Age
Annual Earnings
Date Employed
Hours worked per week
Province of Residence
Add
Remove
Please click the plus button at the bottom to add more employees. When finished, hit the Submit button, and you will be emailed a copy for your reference.
*Note:
S - Single
C - Couple
F - Family
W - Waived (to opt out)
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