Rural Summer Jobs Employer Claim Form 2012

Instructions:

• All Employer Claim Forms must be submitted NO LATER THAN OCTOBER 15, 2012;
• In order to claim wage subsidy, the student eligibility checklist must have been completed for each student and returned to the Ministry;
• The student must confirm total hours worked by signing the declaration below;
• Employers can claim their maximum approved hours and a maximum of 560 hours per student;
• Completed claims forms can be submitted via email, mail or fax
• Faxes will be accepted as originals for the purpose of the Rural Summer Jobs Service program

Section 1: Employer Information

File Number ___________________

Employer/Legal Company name ___________________________________

(Please Print)

Revenue Canada Number (Mandatory) _____________________________

Contact name (First and Last) ____________________________________

Business Phone number _________________________________________

Business fax number ____________________________________________

E-Mail address _________________________________________________

Section 2: Student Declaration - To be completed upon completion of work the term.

By signing below I am confirming that the number of hours worked listed is true and that I have submitted the Student Eligibility Checklist.

Student Name	Total Hours Worked	Student Signature

Section 3: Employer Declaration

I certify that the information regarding the number of hours worked is true and accurate and I further certify that all students have been paid at least the applicable minimum wage. I confirm that I am in compliance with the program criteria. I hereby consent to the collection and use of my business information by the Ministry of Training, Colleges and Universities and the Ministry of Agriculture, Food and Rural Affairs, for the purposes set out in the notice above.

Employer's Signature_________________________
Date ___________________

 

NOTICE: Personal information collected on this form will be used by the Ministry of Training, Colleges and Universities and the Ministry of Agriculture, Food and Rural Affairs to administer the Rural Summer Jobs Service program. The personal information may also be used to contact you to assess client satisfaction. By completing and signing this form, you are consenting to the collection and use of your personal information. Questions about the collection of personal information may be addressed to the Ministry of Agriculture, Food and Rural Affairs, Summer Jobs Service Program Coordinator, 1 Stone Road West, Guelph, ON, N1G 4Y2 or at 1-888-588-4111.