Record of Employment Request Form
Employee #    
Surname   Given  
Street 1  
Street 2
City   Province/State  
Canada & US only
Postal/Zip Code    
E-Mail     Phone    
Supervisor's Name
End date of contract or Last day worked
Additional notes
Payroll will submit your ROE electronicallly to Service Canada. You can access your ROE through your
Service Account via
Enter the characters you see below.
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