Employer Wage Subsidy Form "*" indicates required fields Step 1 of 8 12% EmailThis field is for validation purposes and should be left unchanged.Section 1: Employer InformationBusiness Name*Legal Business Name (if different):Full Mailing Address* Street / Box City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Business Location* Street Address City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Business Phone*Business Email Address* CRA Business Number:*Date Established*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Number of Employees:*Major Products/Service:*Organization type:* Private Not-for-Profit Public Organization Other Business Contact (for subsidy purposes):* First Last Contact Email* Contact Phone:*Are there any employees on lay/off and/or waiting notice of recall?* Yes No Will the subsidy result in the displacement of existing employees?* Yes No Is there a labour stoppage or labour-management dispute in progress?* Yes No If applicable, is the Union concurrence?* Yes No Not applicable Is there a reasonable opportunity for the apprentice to be retained as part of your regular workforce after the wage subsidy ends?* Yes No Section 2: Financial & Insurance InformationFinancial tracking:* Manual Electronic Accountant/Bookkeeper Firm NameAccountant/Bookkeeper* First Last Accountant/Bookkeeper Email* Accountant/Bookkeeper Phone:*Insurance Coverage – Accident* Yes No Insurance Coverage – Liability* Yes No Accident Insurer – Firm Name*Liability Insurer – Firm Name* Section 3: Declaration – Amounts Owing in Default to Province of NLNote: Completion of this declaration is only required if the amount from the requested is $25,000 or more.InstructionsThe information you provide below is collected in accordance with the Canada – Newfoundland and Labrador Labour Market Development Agreement dated September 4, 2008. While the completion of this section is optional, failure to do so may result in a denial of funding.Default AmountNature of the amount in default (penalties, overpayments, etc)NL Benefits and Measures File # Add Remove Section 4: Previous and Current Wage Subsidy AgreementsList past agreements with the Province of NL and/or OAWA NL and their outcomes (if applicable):Provide details of each agreement (click + to add a new item) Add RemoveList current agreements with the Province of NL and/or OAWA NL and their status (if applicable):Provide details of each agreement (click + to add a new item) Add Remove Section 5: Legal Signing AuthoritiesContract PurposesAccording to your incorporating documents, how many signatures are required to bind your organization into a legal agreement?*Please enter a number from 1 to 5.According to your incorporating documents, what combination of signatures are required?*Authorized Signatories:*NameTitleEmail Address Add RemoveContract PurposesHow many signatures are required to sign a payment claim form?*Please enter a number from 1 to 5.What combination of signatures are required?*Authorized Signatories:*NameTitleEmail Address Add RemoveUpload signature specimens for all signatories* Drop files here or Select files Max. file size: 2 MB. Section 6: Participant InformationRequested Start Date:*OAWA NL will confirm.MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Apprentice’s Legal Name:* First Last SINHourly Pay Rate:*Note: MERC costs, vacation pay, stat holidays are not eligible for reimbursement – hourly rates should reflect the base rate.Hours per week:*Note: employers must provide fulltime hours to qualify for Wage Subsidy.Trade/Job Title:*Job Description: Section 7: Participant SupervisionDo you have a certified Journeyperson employed full-time to supervise the apprentices?* Yes No Will the Journeyperson/Apprentice ratio 1:2 for the duration of the Wage Subsidy agreement?* Yes No Journeyperson’s Trade (if Electrical, specify Construction or Industrial):*Name of Supervising Journeyperson as it appears on their certification:* First Last Certificate and/or I.P. Number:*Issuing Province:* Section 8: Note to Applicants regarding lobbyistsApplicants are responsible for ensuring, where applicable, that they adhere to the requirements for registration with the Department of Government Services pursuant to the Lobbyist Registration Act. Detail with respect to the requirements for Lobbyist registration can be found online at http://www.gs.gov.nl.ca/cca/cr or by mailing: Commercial Registration Division, Department of Government Services P.O. Box 8700 St. John’s, NL A1B 4J6Section 9: PrivacyAccess to Information and Privacy Information on this form is collected under the authority of Section 32(c) of the Access to Information and Protection of Privacy Act SNL2002, c.A-1.1 (as amended) and is subject to all provisions under the Act. The personal information collected will be used for the administration of the Newfoundland and Labrador (NL) Wage Subsidies Benefit for which you have applied. That program is provided by the Office to Advance Women Apprentices under an agreement with Newfoundland and Labrador. Newfoundland and Labrador provides the Newfoundland and Labrador (NL) Benefits and Measures program under an agreement with Canada made pursuant to section 63 of the federal Employment Insurance Act. If you have any specific questions concerning the collection, use or disclosure of personal information please contact: Office to Advance Women Apprentices, (709) 757-5434 / The Access to Information and Protection of Privacy Office, (709) 729-7027Section 10: DeclarationThe Applicant (Employer) certifies:• That any proposed participants are not currently employed with the business in any capacity and the Participant/Apprentice will not commence employment until an agreement has been signed with OAWA and a start date established • The information provide above has been read and is understood • The information provided in this application is accurate • An accurate list of all amounts owing to the Province of NL which are past due and in arrears at the time of application has been provided. Any such amounts are limited to those: a) Resulting from Newfoundland and Labrador Benefits and Measures contribution agreements; and b) Having been established after November 2, 2009. • That any such amounts owning to the Province of NL may be deducted from, set off against, or recovered by other means from amounts payable to the Employer under any contribution agreementTo be signed by those specified in Section 5 who may bind the Applicant/Employer into a legal agreementSignatory 1Signatory 1 First Last Signatory 1 TitleSignatory 1 DateMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Signature – Signatory 1Signatory 2Signatory 2 First Last Signatory 2 TitleSignatory 2 DateMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Signature – Signatory 2Signatory 3Signatory 3 First Last Signatory 3 TitleSignatory 3 DateMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Signature – Signatory 3Signatory 4Signatory 4 First Last Signatory 4 TitleSignatory 4 DateMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Signature – Signatory 4Signatory 5Signatory 5 First Last Signatory 5 TitleSignatory 5 DateMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Signature – Signatory 5
