EMPLOYEE PAYROLL INFORMATION  
 
Start Date:

Employee #:

FIRST NAME:

LAST NAME:
   
ADDRESS:
  House # Street Name Apartment #
City:

Province:

Postal Code:

HOME #:

CELL #:

EMAIL ADDRESS:

SOCIAL INS. #:

BIRTH DATE:
  Month Date Year
   
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EMERGENCY CONTACT:
NAME:

TELEPHONE:
   
BANKING INFO:
BANK INFO ATTACHED BANK INFO EMAILED
   
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OFFICE USE ONLY
   
Client Placement:

HOURLY RATE:

WSIB RATE: Light Industrial/Non Clerical
Clerical
Others:
   
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Email Address(To whom the pdf wil be mailed)