TEAM MEMBER EMPLOYMENT INFORMATION PACKAGE New Hire Re-hire Full-time Part-Time Casual Contract

Transcription

1 Employee ID# Last 4 digits of SIN TEAM MEMBER EMPLOYMENT INFORMATION PACKAGE New Hire Re-hire Full-time Part-Time Casual Contract Personal Information Name: Address: City: Postal Code: Home Phone Number: Cell Phone Number: Address: (PLEASE PRINT CLEARLY) Social Insurance Number: Date of Birth: (mm/dd/yy) Start Date: Home Department: Primary Position: Wage: *All pay stubs are ed to Team Members. Should you not provide a valid address, it is your responsibility to come and request your pay stub from HR/Accounting Monday-Friday, 9am-5pm.* Certifications Food & Beverage Team Members & Lifeguards must provide copies of valid certification. Smart Serve: NLS: First Aid & CPR: Aesthetics Certification: Registered Massage Therapist Certification: Safe Food Handling: Banking Information The Americana Conference Resort & Spa has a mandatory direct deposit policy. Please attach a void cheque or provide a statement from your bank. An administration fee of $10.00 per payroll will be applied for those who do not utilize the direct deposit system. lind Entered: Advanced Tracker Payweb

2 Emergency Information In the event of an emergency, please list two (2) contacts: Name: Relationship: Phone Number: Name: Relationship: Phone Number: Confidential Medical Information Doctor s Name: Phone Number: Health Card Number: Allergies or Medical Conditions: Vacation Pay Vacation pay is payable via direct deposit on or before the payday for the period in which the vacation falls in accordance with the Employment Standards Act, Electronic Tax Form Y N I give the Americana Resort Inc. permission to issue an electronic Tax Form (T4/T4A/T5018/RL1) to my addressed provided. I understand that the information collected on this form is for all administrative, legal and business purposes related to my employment with the company and I consent to the collection and use of such information for that purpose. I understand that the information will be retained in my employee file. This information will be disclosed only when required. Team Member Signature Date

3 Team Member Name: Guest Services Date: (Please list quantity and size for each item) Front Desk Agent Night Auditor Reservations x 4 Button Jacket (Blue) x Women s Shirred Shirt (Black) x Men s Polo Shirt (Black) (Issued on loan)* (29.62 purchase / for 3X/4X ) (20.34 purchase) Total: $ Food & Beverage (Please list quantity and size for each item) Boston Pizza x V-Neck Short Sleeve (Black) x V-Neck Long Sleeve (Black) x Button-Up Short Sleeve (Black) (20.00 purchase) (30.00 purchase) (30.00 purchase) x Server Apron (Black) x Cash Pouch (Black) Total: $ (20.00 purchase) (15.00 purchase) Snack Bar x Dri-fit Golf Shirt (blue) x Hat (blue) Apron Total: $ (25.00 purchase) (9.05 purchase) ($15.00 purchase) Banquets x Vest (black) x Tie (black) x Dri-fit Golf Shirt (blue) Total: $ (36.25 purchase) (7.75 purchase) (25.00 purchase) Waves (Please list quantity and size for each item) Lifeguard Pool Attendant - Supervisor x Drifit T-Shirt (blue/green) x Shorts (black) x Hat (black) Total: $ (11.50 purchase) (9.25 purchase) (9.60 purchase) Activities Leader x Dri-fit Shirt (safety green) x Apron (black) x Hat (black) Total: $ (27.00 purchase) (6.50 purchase) (9.60 purchase) Spa & Housekeeping (Please list quantity and size for each item) Spa Attendant RMT Esthetician - Receptionist x Spa Jacket (black) x Dri-fit Golf Shirt (black) x Fleece Sweater (blue) ( purchase) (27.15 purchase) (24.00 purchase) Total: $ Kitchen (Please list quantity for each item) x Chef Coat x Chef Pant x Hat (black) (1.80 per shift worked per pay period) (1.80 per shift worked per pay period) (9.60 purchase) Total: REIMBURSEMENT (Please list quantity and size for each item) Maintenance Safety Boot/Shoe Reimbursement Employee Referral Bonus Reimbursement x CSA Approved Safety Boots/Shoes x ($50.00) ($75.00 semi-annual maximum reimbursement with receipt attached) (Name/Dept. of Referred E/ee) Total: $ Nametag Replacement (Please list quantity for each item) x Silver Nametag x Silver Nametag Insert x POS Swipe Card (8.00 replacement fee) (3.00 replacement fee) (15.00 replacement fee) Total: $ *Bolded items listed above are issued on loan. I understand that upon separation of employment loan items must be returned in good repair or The Americana will withhold the full replacement cost from my final pay cheque. By signing below I authorize The Americana to deduct the cost of all purchase items indicated above from my next pay cheque. Team Member Signature Manager and/or Human Resources Signature 1 Pay $ 2 Pays $ ($50.00 and under) ($51.00 and higher)

4 Excess Hours Agreement Section 17(1) of the Act states that no employer shall require or permit an employee to work more than eight (8) hours in a day, or if the employer establishes a regular work day of more than eight (8) hours for the employee, the number of hours in his or her regular work day and forty eight (48) hours in a work week. Section 17(2) provides that employees may work in excess of those amounts if they agree to do so. The maximum number of hours an employee can agree to work is 60 hours in a week and thirteen (13) hours in a day. An employee can revoke the agreement by giving the employer two weeks written notice. The employer can revoke the agreement by giving the employee reasonable notice. By signing below, I agree to work in excess of eight (8) hours a day to a maximum of 60 hours per week. I, acknowledge that I have been provided with a copy of the most recent version of the Ontario Ministry of Labour information sheet published under s.21.1 of the Employment Standards Act, 2000, entitled Information for Employees About Hours of Work and Overtime Pay. Signature Signature of Employer Date Expiry Date (Not to be more than two years after the date the agreement takes effect.) Overtime Averaging Agreement Section 22(2) of the Employment Standards Act, allows employees to agree to average their hours of work over a period of up to four consecutive weeks (two pay periods) for the purpose of determining their entitlements to overtime pay. This agreement cannot be revoked until the expiry date unless the employee and employer both agree in writing. By signing below, I agree to average my hours over a period up to four weeks for the purpose of determining my entitlement to overtime pay. I, acknowledge that I have been provided with a copy of the most recent version of the Ontario Ministry of Labour information sheet published under s.21.1 of the Employment Standards Act, 2000, entitled Information for Employees About Hours of Work and Overtime Pay. Signature Signature of Employer Date Expiry Date (Not to be more than two years after the date the agreement takes effect.)

5 AMERICANA CONFERENCE RESORT & SPA Team Member Cash Handling Responsibly Agreement The purpose of this agreement is to ensure that all departments receiving cash floats are aware of the related responsibilities and required procedures. This is to acknowledge that in my position I am responsible for the float issued for the duration of my shift, for the safekeeping of said float and returning it in its entirety to the Manager/Supervisor. Cash handling includes but is not limited to cash, credit cards, debit slips, gift cards, coupons, vouchers. By accepting said float, I hereby agree: The said float is to be used solely for company business in the carrying out of my duties. This float is to remain solely within my control, and not accessed by any other staff or management. To verify and count at the beginning of my shift the cash float assigned to me, and immediately report any discrepancies to the Manager/Supervisor for verification and correction. To participate in proper cash handling procedures throughout the duration of my shift. To balance my float at the end of every shift. If any discrepancies occur within my float, I will accept the responsibility of investigating and correcting this discrepancy to the best of my abilities. I understand that any discrepancies must be accounted for and balanced within my own deposit, and cannot be forwarded to the incoming Team Member. All overages or shortages must be deposited and reported on my deposit sheet. To permit auditing of said float with myself present at any time by the Controller, their representative, or other authorized personnel. To provide at any time information requested by my employer. To keep said float in a cash box/drawer or safe. To comply with all rules and regulations concerning the float established by my employer or his agent, including but not limited to petty cash, change handling procedures, funds exchange, etc. By signing below I acknowledge that I have read the above policy and have had an opportunity to ask questions and fully understand the policy. I agree to the following: I will not allow, or participate in improper cash handling in any manner whatsoever. I acknowledge that failure to abide by the above policy will result in a requirement to make restitution for shortages as well as corrective counseling up to and including an unpaid suspension of employment and/or termination. Team Member Name Team Member Signature Date Witness Name Witness Signature Date

6 PARKING AGREEMENT Team Member Name: The Americana Conference Resort & Spa provides complimentary onsite parking to all Team Members who drive to work. I understand that I am required to park in the designated Team Member Parking Area located adjacent to the South entrance of the Grand Ballroom which is located on the East side of the resort (see map below). I understand that I must enter and exit the Resort through the main hotel entrance facing Lundy s Lane. In the event of any changes to this parking agreement I understand that I will be notified and that it is my responsibility to review these communications. Further, I agree to abide by all standard traffic and safety regulations and understand that I am to proceed with caution and abide by the 10km/hr speed limit. I understand that failure to abide by these parking procedures could result in corrective counseling action up to and including suspension without pay and/or termination. Team Member Make, Model & License Plate(s): South East Designated Team Member Parking Area South Entrance No Parking Grande Ballroom No Parking Main Entrance West No Exceptions North Entrance No Parking No Parking Lundy s Lane Team Member Signature: Date:

7 CONSENT FOR THE RELEASE OF POLICE INFORMATION AND DISCLOSURE OF PERSONAL INFORMATION Current Surname (Last Name) First Name Second Name (Middle Name) List All Previous Surname(s) or Maiden Name(s) List All Place of Birth (If other than Canada, please also note date of entry to Canada) Date of Birth (YY-MM-DD) Sex Phone # Driver's Licence Number (required for driver record requests Current Address Number Street Apt/Unit City Province Postal Code Previous Address Number Street Apt/Unit City Province Postal Code Have you ever been convicted of a criminal offence for which a Pardon has not been issued in Canada? YES NO If yes, please complete and attach the Declaration of Criminal Record form I HEREBY CONSENT TO THE SEARCH OF (check all that apply): -AND/OR- Driver Record/Abstract, Please specify Province Check DL License Verification Insurance History, Please specify Province Consumer Credit Report Employment References/Verifications Education/Professional Verifications Terrorism Check I HEREBY CONSENT TO A CRIMINAL RECORD SEARCH (Adult) THROUGH (check all that apply): RCMP National Repository of Criminal Records which will be conducted based on the name(s), date of birth and declared criminal record (as per Section of the CCRTIS Dissemination policy) -AND- Local Police Records which includes Police Information Portal (PIP) Firearms Interest Person (FIP) and Niche RMS * Authorization to Release Clearance Report or Any Police Information I certify that the information I have supplied is correct and true to the best of my knowledge. I consent to the release of a Criminal Record or any Criminal Information to ISB Canada and its partners, and to the Organization Requesting Search named below and its designated agents and/or partners. All data is subject to provincial, state, and federal privacy legislation. The criminal record search will be performed by a police service. I hereby release and forever discharge all members and employees of the Processing Police Service from any and all actions, claims and demands for damages, loss or injury howsoever arising which may hereafter be sustained by myself or as a result of the disclosure of information by the Processing Police Service to ISB Canada and its partners. *I hereby release and forever discharge all agents from any claims, actions, demands for damages, injury or loss which may arise as a result of the disclosure of information by any of the information sources including but not limited the Credit Bureau or Department of Motor Vehicles to the designated agents and/or their partners and representatives. *I am aware and I give consent that the records named above may be transmitted electronically or in hard copy within Canada and to the country from where the search was requested, as indicated below. By signing this waiver, I acknowledge full understanding of the content on this consent form. 2 PIECES OF ACCEPTABLE ID ATTACHED (mandatory if not using eid verifier) Applicants Signature - (mandatory if not using eid verifier) by signing this form you agree and consent to the terms and release of information listed on this consent form. ELECTRONIC IDENTIFICATION VERIFICATION USED (eid from Equifax) By checking this box, you are giving your digital signature and certify that you agree and consent to the terms and release of information listed on this consent form. Candidate address (mandatory) Candidate SIN number (optional, but produces more accurate results) Company Name requesting search (mandatory) Company Name requesting search (mandatory) Company rep witnessing applicant ID and signature (mandatory if not using eid verifier) Company Representative Signature - I verify that I have viewed the Applicant s two pieces of ID (attached) and verified the signature. (mandatory if not using eid verifier) eid Transaction Number (ISB use only) By affixing the ISB stamp and providing the transaction number, ISB Canada certifies that the person named in the above header has passed electronic verification process with Equifax Canada. Location (Country) of Company Requesting Search (mandatory) Location (Country) of Company Requesting Search (mandatory) ISB Canada 8160 Parkhill Drive Milton, ON L9T 5V Fax November 2012

8 ISB Canada 8160 Parkhill Drive Milton, ON L9T 5V Fax September 14, Declaration of Criminal Record *When declaration is submitted, it must be accompanied by the Consent for the Release of Police Information form. PART 1 DECLARATION OF CRIMINAL RECORD (if applicable) Completed by Applicant Surname Given Name Sex Date of Birth (YYYY/MM/DD) Current Address City Province Postal Code Signature of Applicant:. Date: Electronic Identification Verification Used DECLARATION OF CRIMINAL RECORD - does not constitute a Certified Criminal Record by the RCMP - may not contain all criminal record convictions. DO NOT DECLARE THE FOLLOWING: - Absolute discharges or Conditional discharges, pursuant to the Criminal Code, section Any charges for which you have received a Pardon, pursuant to the Criminal Records Act. - Any offences while you were a young person (twelve years old but less than eighteen years old), pursuant to the Youth Criminal Justice Act. - Any charges for which you were not convicted, for example, charges that were withdrawn, dismissed, etc. - Any provincial or municipal offences. - Any charges dealt with outside of Canada. NOTE: A Certified Criminal Record can only be issued based on the submission of fingerprints to the RCMP National Repository of Criminal Records. Offence Date of Sentence Location Consent for the Release of Police Information is attached.

9 All on Board! Dear New Team Member, Thank you for choosing a career at the Americana, we are happy to have you not only as a member of our team, but as part of our family. In choosing a career at the Americana you have chosen to be a part of a dynamic and passionate team who take pride in achieving outstanding results. We look forward to working with you and truly hope that you enjoy being part of our team. Our mission at the Americana is to aspire to be the premiere multifaceted resort destination which exemplifies a level of service that exceeds expectations. Our dynamic and passionate team of hospitality specialists is committed to delivering a truly lasting experience by providing quality and value of which is true to our family heritage. Every Team Member plays a vital role in helping the Americana achieve its mission. We view our Team Members as our greatest strength and we cannot accomplish what we do each and every day without you. Again, welcome to the Americana and thank you for joining our team; we look forward to working with you! Sincerely, Sarah Hachey Sarah Hachey Human Resources Manager

10 New Team Member Welcome Package Health & Safety All Team Members are required to complete the Ministry of Labour Worker Health & Safety Awareness in 4 Steps online training module before their first shift. Upon completion you will receive a certificate which must be handed in to Human Resources on or before your first shift. Click the link below to access the online training: Niagara Ambassador Program Orientation Probation Period Termination Parking Enter/Exit Scheduling Day Off Request Attendance All Team Members are required to complete the Tourism Partnership of Niagara - Niagara Ambassador Program online training. Upon completion, you will receive a certificate which must be handed in to Human Resources on or before your first shift. Click the link below to access the online training: All Team Members will be scheduled for a New Hire Orientation session with Human Resources. Orientation introduces you to our Handbook policies and procedures, Health & Safety Training, WHMIS, and Customer Service Training. The first three (3) months of your employment shall constitute a probationary period. The Americana Resort Inc. may terminate the employment without cause, without notice or pay in lieu thereof within the first three (3) months in accordance with the Employment Standards Act, The Americana Resort Inc. may terminate employment after the three (3) months of probation by providing the minimum notice or pay in lieu thereof provided by the Employment Standards Act, Once you have been provided with the amount of notice or pay in of lieu thereof in accordance with the Employment Standards Act, 2000, as well as any outstanding wages and/or vacation pay, The Americana will have no further obligation to you arising out of the termination of your employment. All Team Members are required to park in the designated parking area located at the south entrance side of the Grand Ballroom. All team members must enter and exit through the main hotel entrance facing Lundy s Lane. Schedules are posted in advance in each department. All Team Members are responsible for checking and writing down their schedule. Some departments receive their schedules via ; please remember that you are still responsible to personally check your schedule. Schedules are subject to change and we encourage you to check your schedule on a regular basis. Requests for time off must be done in writing at least two weeks in advance and submitted to our Manager/Supervisor. Please remember that a request is a request, not a guarantee! You are encouraged to arrive 10 minutes prior to the start of your scheduled shift. If you are not feeling well and/or are unable to attend your scheduled shift you must notify your supervisor/manager a minimum of 2 hours prior to the start of your shift. You must make every attempt to speak directly to your Manager before leaving a message. If you are unable to speak to your manager please call Front Desk and ask to speak with the Manager on Duty and inform them of your absence. You may be asked to provide a doctor s note at the beginning of your next scheduled shift for absences due to illness. Failure to provide a Doctor s note is considered an unexcused absence and may result in corrective counseling

11 Breaks Smoking Punctuality Timekeeping Pay Vacation Public Holidays Personal Appearance Lockers All Team Members are entitled to one unpaid ½ hour break after working 5 consecutive hours. If you work over 10.5 hours you are entitled to an additional ½ hour unpaid break. All Team Members are required to take their breaks; it s the healthy thing to do! If you leave company property for your break period you are must sign out when you leave and sign back in upon arrival. In the event of an emergency we need to be able to account for everyone! Team Members are only permitted to smoke during their designated break periods in the designated fenced smoking area located outside entrance # 6. All Team Members are responsible for prompt and regular attendance. Tardiness and excessive absenteeism will not be tolerated and may result in corrective counseling. All Team Members are required to scan in and sign in at the beginning of their shift and scan out and sign out at the end of their shift; please do not scan in any sooner than 10 minutes prior to your scheduled shift. Pay is based on two-week period beginning on Sunday and ending on Saturday; we are paid bi-weekly on Thursday via direct deposit. All Team Members receive their pay stubs via . Paystubs are ed as a password protected PDF document. The password to access your paystub is your social insurance number, all 9 digits, no spaces. All Team Members are entitled to two weeks (10 days) vacation after the completion of their first year of employment. Vacation pay is accrued and based on 4% of your earnings. Vacation pay is paid out when vacation time is taken. Any unused vacation pay is paid out annually in November. Vacation requests must be made 8 weeks in advance on the Vacation Request form. Requests are subject to approval and may be denied during our peak season May to September and during holiday and holiday break periods. The Americana recognizes nine (9) statutory holidays annually. All Team Members are entitled to the following statutory holidays or holiday pay for work on these holidays: New Years Day, Family Day, Good Friday, Victoria Day, Canada Day, Labour Day, Thanksgiving Day, Christmas Day, Boxing Day. Team Members qualify for the public holiday entitlement unless they: Fail without reasonable cause to work all of their regularly scheduled days of work before or after the public holiday (this is called the First and Last Rule ) or, fail without reasonable cause to work their entire shift on the public holiday if they agreed to or were required to work that day. If you are required to work on the statutory holiday and qualify for public holiday entitlement you will receive your regular rate for hours worked on the holiday, plus a substitute holiday with public holiday pay. The substitute holiday must be scheduled for no more than three months after the public holiday. If you have earned a substitute holiday with public holiday pay, this calculation is done for the four (4) work weeks before the work week in which the substitute day falls on. The substitute holiday day must be scheduled for no more than three months after the public holiday. Any exceptions to this rule must be reviewed and approved by senior management. All Team Members are expected to report to work in a clean, pressed and well maintained uniform. Please note that your nametag is part of your uniform and must be worn at all times. Take pride in your appearance! Lockers are provided to all Team Members at no cost in the Staff Room. Please provide your own lock. Items such as keys, wallets, jackets, cell phones, etc. must be kept in your locker or vehicle. Team Members are not permitted to keep their cell phone on them while working. You may use them during your designated break period only

12 Staff Room Workplace Injury Team Member Discounts Tour Job Description Located at the bottom of the stairs next to the Front Desk. The code to enter is All Team Members are responsible for keeping this area clean and tidy. If you order food from Boston Pizza please remember that you are responsible to return any used dishes/cutlery to the restaurant. In the event that you are to injure yourself at work please follow these steps. 1) Promptly obtain first aid. 2) Notify your supervisor/manager immediately. 3) Complete a team member accident/incident report with your Manager/Supervisor. 4) If medical attention is required obtain a return to work package. 5) Give the doctor the functional abilities form to complete. 6) Return all forms to Human Resources the same or next day. As a Team Member you are entitled to the following discounts throughout the resort: Free coffee / tea / from the Staff Room while on duty Free Pop from Oasis Snack Bar using your own clear refillable container while on duty Boston Pizza 40% off while on-duty / 15% off while off-duty Oasis Snack Bar: 50% off while on-duty / 25% off while off-duty Field s Bistro & Gathering Place: $5.00 single portion while on-duty / 15% off when off-duty LuLu s Coffee Kiosk: 30% off food & beverage items only Senses Spa: 50% off treatments / 10% off retail / 25% off Dermalogica products Waves Waterpark FREE entry for all Team Members Accommodations Employee / Friends & Family rates available You will go on a tour of the Americana with your manager/supervisor within your first week. All Team Members should be introduced to the Management Team, fellow Team Members and know where all areas of the resort are located i.e. Boston Pizza, Senses Spa, Snack Bar, Housekeeping, Human Resources/Accounting, etc. All Team Members will receive a formal job description during their initial meeting with Human Resources. The purpose of the job description is to give every Team Member a full understanding of their job duties, expectations and standards of performance. Americana Resort Inc. is committed to providing a work environment and practices that are inclusive and barrier-free based on the grounds as defined by the Ontario Human Rights Code. In the event accommodation is required you must advise the Americana Resort Inc. in writing, whenever possible. The Americana Resort Inc. may require further information related to the accommodation request. Requests for accommodation based on a disability must be supported by medical documentation. Requests for accommodation will be provided to the point of undue hardship as defined by the Ontario Human Rights Commission s Policy and Guidelines on Disability and the Duty to Accommodate. I acknowledge that I have read and understood the above items. I understand that I will receive more indepth on-the-job training as well as attend a New Hire Orientation session. I agree to follow the policies and procedures listed above while working for the Americana. I acknowledge that the Americana has provided me with the most recent copy of the Employment Standards Act, 2000 What You Should Know poster. Print Name Team Member Signature Date - 4 -

13 2017 Personal Tax Credits Return Read page 2 before filling out this form. Your employer or payer will use this form to determine the amount of your tax deductions. Fill out this form based on the best estimate of your circumstances. Protected B when completed TD1 Last name First name and initial(s) Date of birth (YYYY/MM/DD) Employee number Address Postal code For non-residents only Country of permanent residence Social insurance number 1. Basic personal amount Every resident of Canada can claim this amount. If you will have more than one employer or payer at the same time in 2017, see "More than one employer or payer at the same time" on page 2. If you are a non-resident, see "Non-residents" on page 2. 11, Family caregiver amount for infirm children under age 18 Either parent (but not both), may claim $2,150 for each infirm child born in 2000 or later, that resides with both parents throughout the year. If the child does not reside with both parents throughout the year, the parent who is entitled to claim the Amount for an eligible dependant on line 8 may also claim the family caregiver amount for that same child who is under age Age amount If you will be 65 or older on December 31, 2017, and your net income for the year from all sources will be $36,430 or less, enter $7,225. If your net income for the year will be between $36,430 and $84,597 and you want to calculate a partial claim, get Form TD1-WS, Worksheet for the 2017 Personal Tax Credits Return, and fill in the appropriate section. 4. Pension income amount If you will receive regular pension payments from a pension plan or fund (excluding Canada Pension Plan, Quebec Pension Plan, Old Age Security, or Guaranteed Income Supplement payments), enter $2,000 or your estimated annual pension income, whichever is less. 5. Tuition (full time and part time) If you are a student enrolled at a university or college, or an educational institution certified by Employment and Social Development Canada, and you will pay more than $100 per institution in tuition fees, fill in this section. If you are enrolled full time or part time, enter the total of the tuition fees you will pay. 6. Disability amount If you will claim the disability amount on your income tax return by using Form T2201, Disability Tax Credit Certificate, enter $8, Spouse or common-law partner amount If you are supporting your spouse or common-law partner who lives with you and whose net income for the year will be less than $11,635 ($13,785 if he or she is infirm) enter the difference between this amount and his or her estimated net income for the year. If his or her net income for the year will be $11,635 or more ($13,785 or more if he or she is infirm), you cannot claim this amount. 8. Amount for an eligible dependant If you do not have a spouse or common-law partner and you support a dependent relative who lives with you, and whose net income for the year will be less than $11,635 ($13,785 if he or she is infirm and you cannot claim the family caregiver amount for children under age 18 for this dependant), enter the difference between this amount and his or her estimated net income. If his or her net income for the year will be $11,635 or more ($13,785 or more if he or she is infirm), you cannot claim this amount. 9. Caregiver amount If you are taking care of a dependant who lives with you, whose net income for the year will be $16,163 or less, and who is either your or your spouse's or common-law partner's: parent or grandparent (aged 65 or older), enter $4,732 ($6,882 if he or she is infirm); or relative (aged 18 or older) who is dependent on you because of an infirmity, enter $6,882. If the dependant's net income for the year will be between $16,163 and $20,895 ($16,163 and $23,045 if he or she is infirm) and you want to calculate a partial claim, get Form TD1-WS and fill in the appropriate section. 10. Amount for infirm dependants age 18 or older If you support an infirm dependant age 18 or older who is your or your spouse's or common-law partner's relative, who lives in Canada, and whose net income for the year will be $6,902 or less, enter $6,883. You cannot claim an amount for a dependant if you or anyone else has already claimed it on line 8 or 9. If the dependant's net income for the year will be between $6,902 and $13,785 and you want to calculate a partial claim, get Form TD1-WS and fill in the appropriate section. 11. Amounts transferred from your spouse or common-law partner If your spouse or common-law partner will not use all of his or her age amount, pension income amount, tuition amount, or disability amount on his or her income tax return, enter the unused amount. 12. Amounts transferred from a dependant If your dependant will not use all of his or her disability amount on his or her income tax return, enter the unused amount. If your or your spouse's or common-law partner's dependent child or grandchild will not use all of his or her tuition amount on his or her income tax return, enter the unused amount. 13. TOTAL CLAIM AMOUNT Add lines 1 to 12. Your employer or payer will use this amount to determine the amount of your tax deductions. TD1 E (17) (Vous pouvez obtenir ce formulaire en français à arc.gc.ca/formulaires ou en composant le ). Page 1 of 2

14 Filling out Form TD1 Protected B when completed Fill out this form only if: you have a new employer or payer and you will receive salary, wages, commissions, pensions, employment insurance benefits, or any other remuneration; you want to change amounts you previously claimed (for example, the number of your eligible dependants has changed); you want to claim the deduction for living in a prescribed zone; or you want to increase the amount of tax deducted at source. Sign and date it, and give it to your employer or payer. If you do not fill out Form TD1, your employer or payer will deduct taxes after allowing the basic personal amount only. More than one employer or payer at the same time If you have more than one employer or payer at the same time and you have already claimed personal tax credit amounts on another Form TD1 for 2017, you cannot claim them again. If your total income from all sources will be more than the personal tax credits you claimed on another Form TD1, check this box, enter "0" on line 13 and do not fill in lines 2 to 12. Total income less than total claim amount Check this box if your total income for the year from all employers and payers will be less than your total claim amount on line 13. Your employer or payer will not deduct tax from your earnings. Non-residents (Only fill in if you are a non-resident of Canada.) As a non-resident of Canada, will 90% or more of your world income be included in determining your taxable income earned in Canada in 2017? Yes (Fill out the previous page.) No (Enter "0" on line 13, and do not fill in lines 2 to 12 as you are not entitled to the personal tax credits.) If you are unsure of your residency status, call the international tax and non-resident enquiries line at Provincial or territorial personal tax credits return If your claim amount on line 13 is more than $11,635, you also have to fill out a provincial or territorial TD1 form. If you are an employee, use the Form TD1 for your province or territory of employment. If you are a pensioner, use the Form TD1 for your province or territory of residence. Your employer or payer will use both this federal form and your most recent provincial or territorial Form TD1 to determine the amount of your tax deductions. If you are claiming the basic personal amount only (your claim amount on line 13 is $11,635), your employer or payer will deduct provincial or territorial taxes after allowing the provincial or territorial basic personal amount. Note: If you are a Saskatchewan resident supporting children under 18 at any time during 2017, you may be able to claim the child amount on Form TD1SK, 2017 Saskatchewan Personal Tax Credits Return. Therefore, you may want to fill out Form TD1SK even if you are only claiming the basic personal amount on this form. Deduction for living in a prescribed zone If you live in the Northwest Territories, Nunavut, Yukon, or another prescribed northern zone for more than six months in a row beginning or ending in 2017, you can claim: $11.00 for each day that you live in the prescribed northern zone; or $22.00 for each day that you live in the prescribed northern zone if, during that time, you live in a dwelling that you maintain, and you are the only person living in that dwelling who is claiming this deduction. Employees living in a prescribed intermediate zone can claim 50% of the total of the above amounts. For more information, go to cra.gc.ca/northernresidents. Additional tax to be deducted You may want to have more tax deducted from each payment, especially if you receive other income, including non-employment income such as CPP or QPP benefits, or old age security pension. By doing this, you may not have to pay as much tax when you file your income tax return. To choose this option, state the amount of additional tax you want to have deducted from each payment. To change this deduction later, fill out a new Form TD1. $ $ Reduction in tax deductions You can ask to have less tax deducted on your income tax return if you are eligible for deductions or non-refundable tax credits that are not listed on this form (for example, periodic contributions to a registered retirement savings plan (RRSP), child care or employment expenses, charitable donations, and tuition and education amounts carried forward from the previous year). To make this request, fill out Form T1213, Request to Reduce Tax Deductions at Source, to get a letter of authority from your tax services office. Give the letter of authority to your employer or payer. You do not need a letter of authority if your employer deducts RRSP contributions from your salary. Personal information is collected under the Income Tax Act to administer tax, benefits, and related programs. It may also be used for any purpose related to the administration or enforcement of the Act such as audit, compliance and the payment of debts owed to the Crown. It may be shared or verified with other federal, provincial/territorial government institutions to the extent authorized by law. Failure to provide this information may result in interest payable, penalties or other actions. Under the Privacy Act, individuals have the right to access their personal information and request correction if there are errors or omissions. Refer to Info Source at cra.gc.ca/gncy/tp/nfsrc/nfsrc-eng.html, Personal Information Bank CRA PPU 120. Certification I certify that the information given on this form is correct and complete. Signature It is a serious offence to make a false return. Date YYYY/MM/DD Page 2 of 2

15 2017 Ontario Personal Tax Credits Return Protected B when completed TD1ON Read page 2 before filling out this form. Your employer or payer will use this form to determine the amount of your provincial tax deductions. Fill out this form based on the best estimate of your circumstances. Last name First name and initial(s) Date of birth (YYYY/MM/DD) Employee number Address Postal code For non-residents only Country of permanent residence Social insurance number 1. Basic personal amount Every person employed in Ontario and every pensioner residing in Ontario can claim this amount. If you will have more than one employer or payer at the same time in 2017, see "More than one employer or payer at the same time" on page 2. 10, Age amount If you will be 65 or older on December 31, 2017, and your net income from all sources will be $36,969 or less, enter $4,966. If your net income for the year will be between $36,969 and $70,076 and you want to calculate a partial claim, get Form TD1ON-WS, Worksheet for the 2017 Ontario Personal Tax Credits Return, and fill in the appropriate section. 3. Pension income amount If you will receive regular pension payments from a pension plan or fund (excluding Canada Pension Plan, Quebec Pension Plan, Old Age Security, or Guaranteed Income Supplement payments), enter $1,406, or your estimated annual pension income, whichever is less. 4. Tuition and education amounts (full time and part time) If you are a student enrolled at a university, college, or educational institution certified by Employment and Social Development Canada, and you will pay more than $100 per institution in tuition fees, fill in this section. If you are enrolled full time, or if you have a mental or physical disability and are enrolled part-time, enter the total of the tuition fees you will pay for the periods before September 5, 2017, plus $547 for each month before September 2017 that you will be enrolled. If you are enrolled part-time and do not have a mental or physical disability, enter the total of the tuition fees you will pay for the periods before September 5, 2017, plus $164 for each month before September 2017 that you will be enrolled part-time. 5. Disability amount If you will claim the disability amount on your income tax return by using Form T2201, Disability Tax Credit Certificate, enter $8, Spouse or common-law partner amount If you are supporting your spouse or common-law partner who lives with you and whose net income for the year will be $864 or less, enter $8,636. If his or her net income for the year will be between $864 and $9,500 and you want to calculate a partial claim, get Form TD1ON-WS and fill in the appropriate section. 7. Amount for an eligible dependant If you do not have a spouse or common-law partner and you support a dependent relative who lives with you and whose net income for the year will be $864 or less, enter $8,636. If his or her net income for the year will be between $864 and $9,500 and you want to calculate a partial claim, get Form TD1ON-WS and fill in the appropriate section. 8. Caregiver amount If you are taking care of a dependant who lives with you, whose net income for the year will be $16,401 or less, and who is either your or your spouse's or common-law partner's: parent or grandparent (aged 65 or older); or relative (aged 18 or older) who is dependent on you because of an infirmity, enter $4,794. If the dependant's net income for the year will be between $16,401 and $21,195 and you want to calculate a partial claim, get Form TD1ON-WS and fill in the appropriate section. 9. Amount for infirm dependants age 18 or older If you are supporting an infirm dependant aged 18 or older who is your or your spouse's or common-law partner's relative, who lives in Canada, and whose net income for the year will be $6,814 or less, enter $4,794. You cannot claim an amount for a dependant you claimed on line 8. If the dependant's net income for the year will be between $6,814 and $11,608 and you want to calculate a partial claim, get Form TD1ON-WS and fill in the appropriate section. 10. Amounts transferred from your spouse or common-law partner If your spouse or common-law partner will not use all of his or her age amount, pension income amount, tuition and education amounts, or disability amount on his or her income tax return, enter the unused amount. 11. Amounts transferred from a dependant If your dependant will not use all of his or her disability amount on his or her income tax return, enter the unused amount. If your or your spouse's or common-law partner's dependent child or grandchild will not use all of his or her tuition and education amounts on his or her income tax return, enter the unused amount. 12. TOTAL CLAIM AMOUNT Add lines 1 to 11. Your employer or payer will use this amount to determine the amount of your provincial tax deductions. TD1ON E (17) (Vous pouvez obtenir ce formulaire en français à arc.gc.ca/formulaires ou en composant le ) Page 1 of 2

16 Filling out Form TD1ON Fill out this form only if you are an employee working in Ontario or a pensioner residing in Ontario and any of the following apply: Protected B when completed you have a new employer or payer and you will receive salary, wages, commissions, pensions, employment insurance benefits, or any other remuneration; you want to change amounts you previously claimed (for example, the number of your eligible dependants has changed); or you want to increase the amount of tax deducted at source. Sign and date it, and give it to your employer or payer. If you do not fill out Form TD1ON, your employer or payer will deduct taxes after allowing the basic personal amount only. More than one employer or payer at the same time If you have more than one employer or payer at the same time and you have already claimed personal tax credit amounts on another Form TD1ON for 2017, you cannot claim them again. If your total income from all sources will be more than the personal tax credits you claimed on another Form TD1ON, check this box, enter "0" on line 12 and do not fill in lines 2 to 11. Total income less than total claim amount Check this box if your total income for the year from all employers and payers will be less than your total claim amount on line 12. Your employer or payer will not deduct tax from your earnings. Additional tax to be deducted If you wish to have more tax deducted, fill in "Additional tax to be deducted" on the federal Form TD1. Reduction in tax deductions You can ask to have less tax deducted on your income tax return if you are eligible for deductions or non-refundable tax credits that are not listed on this form (for example, periodic contributions to a registered retirement savings plan (RRSP), child care or employment expenses, charitable donations, and tuition and education amounts carried forward from the previous year). To make this request, fill out Form T1213, Request to Reduce Tax Deductions at Source, to get a letter of authority from your tax services office. Give the letter of authority to your employer or payer. You do not need a letter of authority if your employer deducts RRSP contributions from your salary. Forms and publications To get our forms and publications, go to cra.gc.ca/forms or call Personal information is collected under the Income Tax Act to administer tax, benefits, and related programs. It may also be used for any purpose related to the administration or enforcement of the Act such as audit, compliance and the payment of debts owed to the Crown. It may be shared or verified with other federal, provincial/territorial government institutions to the extent authorized by law. Failure to provide this information may result in interest payable, penalties or other actions. Under the Privacy Act, individuals have the right to access their personal information and request correction if there are errors or omissions. Refer to Info Source at cra.gc.ca/gncy/tp/nfsrc/nfsrc-eng.html, Personal Information Bank CRA PPU 120. Certification I certify that the information given on this form is correct and complete. Signature It is a serious offence to make a false return. Date Page 2 of 2