Fillable Printable EMPLOYMENT PROGRAM OF BRITISH COLUMBIA WAGE
Fillable Printable EMPLOYMENT PROGRAM OF BRITISH COLUMBIA WAGE
EMPLOYMENT PROGRAM OF BRITISH COLUMBIA WAGE
The Employment Program of British Columbia is funded by
the Government of Canada and the Province of British Columbia
EMPLOYMENT PROGRAM OF BRITISH COLUMBIA
WAGE SUBSIDY PLACEMENT INCENTIVE
EMPLOYER APPLICATION
SD3352(12/04/1)
Page 1 of 2
is contracted by the Province of British Columbia to provide services to clients of
the Employment Program of British Columbia.
Service Provider use only
Field Identifier:
(Employment Services Centre staff are available to help you complete this form)
Section 1: BUSINESS PROFILE
Organization Name
CRA Business Number
Address
City / Town
Province
Postal Code
Telephone #
FAX #
Have you ever participated in the Wage Subsidy
Service or Targeted Wage Subsidy program?
Yes
No
If "Yes", when?
With which service provider?
Type of Sector
Type of Organization
No. of Years
of Operations
Size of Organization
(number of employees)
Briefly describe your organization and the types of workers you employ by occupation type:
Has your organization recently experienced any lay-offs?
Yes
No
Will the subsidy result in the displacement of existing employees or volunteers?
Yes
No
Is there a labour stoppage or labour - management dispute in progress?
Yes
No
Is there Union concurrence (if applicable)?
No
Yes
Does your organization have 3rd Party liability coverage?
No
Yes
Do you have WSBC coverage? If 'yes' please provide number
No
Yes
WSBC Number:
Legal Signing Officers
How many signatures (according to your letter patent or other incorporation documents) are required to bind your organization into a legal agreement?
What combination of signatures below (according to your letters patent or other incorporation documents) are required to bind your organization into a legal agreement?
Please provide name, title and specimen signature for the person(s) authorized to sign:
Name
Title
Specimen Signature
The Employment Program of British Columbia is funded by
the Government of Canada and the Province of British Columbia
EMPLOYMENT PROGRAM OF BRITISH COLUMBIA
WAGE SUBSIDY PLACEMENT INCENTIVE
EMPLOYER APPLICATION
SD3352(12/04/1)
Page 2 of 2
is contracted by the Province of British Columbia to provide services to clients of
the Employment Program of British Columbia.
Section 2: TRAINING POSITION INFORMATION - Complete a separate page for each DIFFERENT type of position
Training site address (if different from above)
Contact Name
CRA Business Number
Telephone
FAX
E-mail address
Training Position title
Number of available positions
Anticipated Start date (DD/MM/YYYY)
End Date of Subsidy
Hours of work
Rate of pay
Wage Subsidy Amount of Funding Requested
Wage Subsidy Length Requested
Description of duties and components of job:
Basic skills and competencies required for the training position:
What training and supervision are you able/willing to provide for the new employee?
Other requirements (if any)
Rationale for Request
Section 3: DECLARATION AND SIGNATURE
NOTE: Intentional falsification of information on this form may lead to termination and exclusion from all Employment Program of British
Columbia Programs and services.
I am authorized to act on behalf of the Employer and the information on this form is complete and accurate.
Signature
Title
Start Date (YYYY MMM DD)
Service Provider Use Only (assessment of training opportunity/ work site):
