Employer Registration Form Business Number Registered Name Registered Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Business Address If different from Registered Address Address 1 Address 2 City State/Province Zip/Postal Code Country Trading Name If different from Registered Name Primary Telephone Number (###) ### #### Fax Number (###) ### #### Primary Contact First Name Last Name Primary Contact Title Primary Contact Email Address Primary Contact Telephone Number (###) ### #### Size of Business Number of Employees 1 - 10 11 - 20 21 - 30 30+ Type of Business Service Primary (Incl. Agriculture) Retail Manufacturing Other Type of Sector Private Public Not-For-Profit Other Number of Years in Business Open Position Title Start Date MM DD YYYY Scheduled Days Monday Tuesday Wednesday Thursday Friday Saturday Sunday Hours of Work Rate of Pay $ Description of Duties Basic Skills Required for the Position Other Requirements, if Any Thank you!We will be in touch shortly regarding your application.
