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Section B1 – Information about the Employer

IMPORTANT: Is your claim submission related to a temporary help agency?*

  • Please put a check mark () in the “Yes” box if:
    1. You are or were employed by a temporary help agency to perform work on a temporary basis for client(s) of the agency and you are filing a claim against the agency (for example, you were charged a fee for filling out an application or helping you enter a resume).
    2. You are or were employed by a temporary help agency and you are filing a claim against a client of the agency.
    3. You were charged prohibited fees by the agency (for example, you were charged a fee for filling out an application or helping you enter a resume) and you are filing a claim against the agency.
  • Put a check mark () in the “No” box if your employer is not a temporary help agency.

Employer’s Business Name (Please provide the legal name or name of company)*

If you know your employer’s legal name, write it on the form. The employer’s legal name may be on your pay cheque, pay stub, or T4 slip. The employer’s legal name may be different from the name it operates as. For example, the employer’s legal name might be 123456 Ontario Inc. and operate as John Smith & Sons.

If you do not know the employer’s legal name, write down what you know about the employer / business name. If you do not know any business name, please write “don’t know”.

If this employer operates using any other name(s), please provide these names.

Some employers will have a legal and a business or operating name. See explanation above. Please write the employer’s operating name or business name here if it is different from the legal name. If you know the employer or business has different name(s), write them in this section.

Type of Business

Please describe the type of work this business does. For example, "Fast Food," or "Computer sales."

Business Number

The Ontario government uses business numbers as easy way to identify employers. This number is in reference to your employer's Canada Revenue Agency Business Number. You can find this number on your Record of Employment (ROE). This number will help us check the identity of the business you are claiming has violated your employment standards rights. If you know this number, please write it on the form.

Is this Business: Still operating?

  • Put a check mark () in the “Still operating” box if your employer’s business is still operating, is still open or is still in business.
  • Put a check mark () in the “No longer operating” box if your employer’s business is no longer operating, has closed or shut down.
  • Put a check mark () in the “In receivership/bankruptcy” box if you know the employer is bankrupt or in receivership.
  • Put a check mark () in the “Do not know” box if you do not know the operating status of your employer's business.

Note: If your employer is bankrupt or in receivership, and your employment has been terminated, please consult the federal government’s Wage Earners' Protection Program for more information on money you may be entitled to receive.

Address of the Employer (For example, Head Office, Main Office, or Headquarters)*

Please put the employer’s head office, main office, or headquarters location here.

Examples:

  1. If you work for a construction company that has a head office in Toronto, but you work at a site in Hamilton, put the Toronto head office address here and the Hamilton site location in the space provided for "address of the location where you work(ed)".
  2. If you work for a large manufacturer in one of their factories in Sudbury and the manufacturer’s headquarters is in the United States, put the headquarter address (United States) here and the location of the factory where you work in the space provided for "address of the location where you work(ed)".
  3. If you work for a temporary help agency in downtown Ottawa and you perform work for one of their client businesses in Kanata, provide the temporary help agency's Ottawa address here and the address of the client business in the space provided for "address of the location where you work(ed)."

Put a check mark () in the "I don’t know my employer's address" box if you don’t know your employer's address.

Address of the location where you work(ed)

Write the address where you performed your job if it is different from the employer’s head office, main office, headquarters, or address provided above. See examples provided above.

If the location where you work(ed) is the same as your employer’s address, put a check mark () in the "Same as above" box.

Additional Information about the Employer

Employer's Email Address

If you know the email address of your employer, please write it on the form.

Employer's Website

If you know the website of your employer, please write the website address on the form. For example, “www.example.com.”

Name of your supervisor, or contact

If you know the name and position of the person you reported to at work, please write it on the form.

Employer’s Telephone No.

If you know your employer’s telephone number, please write it on the form.

Employer's Fax No.

If you know your employer's fax number, please write it on the form.

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This information is provided as a public service. Although we endeavour to ensure that the information is as current and accurate as possible, errors do occasionally occur. Therefore, we cannot guarantee the accuracy of the information. Readers should, where possible, verify the information before acting on it.

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