Employer: Hamilton CTC

How did you hear about us?: * Required

Corportate Business Name: * Required

Registered Legal Name: * Required

Contact First Name: * Required

Contact Last Name: * Required

Canada Revenue Agency/Business:

Choose the industry that best represents your business? * Required

Total Number of Employees in Corporation

Employer Business Size

Year Business Registered (YYYY):

Preferred Language:

Preferred Communication: Phone:

Preferred Communication: Email:

Email:

Work Phone (include ext, if applicable):

Cell Phone (include ext, if applicable):

Corporate Street Number/Address: * Required

Corporate Address Unit Number (if applicable):

Corporate City/Town:

Corporate Province:

Corporate Postal Code:

Corporate PO Box:

Closest major intersection, if applicable:

Type of Business:

Type of Sector:

If other sector, specify:

Briefly describe your business and the types of occupations it supports:

Is your company currently/ recently involved in lay-offs?:

Do you have third party liability coverage?:

Which type of workplace safety insurance do you have?:

If selected alternative workplace safety insurance coverage, specify:

Employer Communication Consent, Waiver, Release and Indemnity Agreement: I agree/I do not agree * Required


Employer Application How did you hear about us?: * Required Corportate Business Name: * Required Registered Legal Name: * Required Contact First Name: * Required Contact Last Name: * Required Canada Revenue Agency/Business: Choose the industry that best represents your business? * Required Total Number of Employees in Corporation Employer Business Size Year Business Registered (YYYY): Preferred Language: Preferred Communication: Phone: Preferred Communication: Email: Email: Work Phone (include ext, if applicable): Cell Phone (include ext, if applicable): Corporate Street Number/Address: * Required Corporate Address Unit Number (if applicable): Corporate City/Town: Corporate Province: Corporate Postal Code: Corporate PO Box: Closest major intersection, if applicable: Type of Business: Type of Sector: If other sector, specify: Briefly describe your business and the types of occupations it supports: Is your company currently/ recently involved in lay-offs?: Do you have third party liability coverage?: Which type of workplace safety insurance do you have?: If selected alternative workplace safety insurance coverage, specify: Read here: Employer Communication Consent, Waiver, Release and Indemnity Agreement Employer Communication Consent, Waiver, Release and Indemnity Agreement: I agree/I do not agree * Required Please leave this checkbox blank