Government of Ontario: Ministry of Labour

Jobs Protection Office
347 Preston Street, Suite 430
Ottawa ON K1S 3J4
Toll Free: 1 888 998-9959
Telephone: 613 288-3847
Fax: 613 727-2900

Worker Registration Application for Specialized Work

Ontario-Quebec Construction Labour Mobility Agreement

Check one

New Registration Amendment Renewal

Registration No.

Registration Identification

Applicant Last Name
Applicant First Name

Home Address

Unit No.
Street No.
Street Name
PO Box
City/Town
Province
Postal Code

Home Telephone No.
Cell No.
Fax No.
Email

Employer Information

Employer Name
Position

Head Office Address

Unit No.
Street No.
Street Name
PO Box
City/Town
Province
Postal Code

Telephone No.
Fax No.
Project Location

Applicant Signature

I, the undersigned, declare that the information provided and attached is true and complete. I authorize the Jobs Protection Office to verify all information included in this application.
Falsification of information will lead to cancellation of this application.

Applicant Signature

Applicant Signature Date (yyyy/mm/dd)

Ontario Government Use Only

Specialized Work

Proof of Manufacturer Training

Copies of paystub/T-4 or Notice of Assessment

Proof of H&S Training

Processor Name
Processor Date (yyyy/mm/dd)
Approver (Manager, Jobs Protection office)
Approver Date (yyyy/mm/dd)