Special Projects Program Application for Employers

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Personal information on this form is collected under section 31(c) of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, c. F-15.01 as it relates directly to and is necessary for the administration of the PEI Employment Development Agency’s programs and will be used for determining program eligibility and maintaining program data for statistical purposes. If you have any questions about this collection of personal information, you may contact the Executive Director of the PEI Employment Development Agency, 548 Main Street, PO Box 1180, Montague, PE, C0A 1R0, Telephone 902-838-0910.

Identification

Business/Organization Name

Contact First Name

Contact Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone 1

For example 902-555-5555

Telephone 2

For example 902-555-5555

Fax Number

For example 902-555-5555

Email Address

Revenue Canada Payroll Number

Workers Compensation Board Number

Business Name Registry Number

Are you interested in having an Employer account created for you on WorkPEI.ca on your behalf?

WorkPEI is a one-stop employment website connecting local employers and job seekers in Prince Edward Island.

Is your mailing address different than your civic address?

Mailing Address

Address 1

Address 2

City, Town or Community

Province

Alternate Contact

Contact First Name

Contact Last Name

Telephone Number

For example: 902-555-5555

Email Address