Record of Employment Request Form (Casual Employees)

Name*
FirstLast
Address*
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
Email*
Phone*
Employee #*
(9-digit number)
First Day Worked (Estimate)*
Last Day Worked (Estimate)*
Supervisor's Name*
Reason for Leaving:*
- End of Contract / Shortage of Work
- End of Term
- Other (Please specify below)
Payroll will notify you by email or phone when your ROE is available on the Service Canada website.