Q4 Employee Information Form

Employee Information PLEASE PRINT:

Last Name:

Mailing address (incl. postal code):

First Name:

Preferred Name:

Date of Birth:

Home Phone:

SIN:

Mobile Phone:

Gender: Female Male Private e-mail:

Emergency Contact: (Please up-date future changes)

Name:

Relationship:

Emergency Number:

Alternate Number:

Banking Information: (Please attach a Voided Cheque)

Bank Name:

Bank No (3 digits):

Branch No/Transit No/Routing No (5

digits):

Account No (7 or 11 digits):

Full Bank Address:

The personal information you provided in this form will be held by Q4 for the purpose of fulfilling local employment law obligations and employee management.

Your personal information will be held by Q4 and not communicated to anyone outside the company without your permission, except as may be required to

comply with applicable laws. I hereby confirm that the information I provided in this form is correct:

Date

Employee Signature

To

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co

mp

lete

d b

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Position Title: Career

Level:

Job

Code:

Date of hire:

Department: Cost Centre:

Annual Base Salary:

Manager: Other:

Annual Variable:

Benefits:

□ Entered into SL:

Annual Vacation:

TD-1 Basic Exemption:

TD1-ON Basic Exemption: