COVID-19 EMPLOYMENT INTAKE FORM

Your Name: (required)

Email Address: (required)

Phone Number: (required)

If you would like to expedite the intake process please answer the questions below - if not one of our
lawyers or clerks will reach out to you as soon as possible

I'll answer the questionsYesNo

1. Are you an employer or employee? EmployerEmployee

Employer

2.Business Name:

3. Is your business a:

a. Sole ProprietorshipDefinition: A sole proprietorship is an unincorporated business that is owned by one individual. It is the simplest kind of business structure. If you are a sole proprietor, you pay personal income tax on the net income generated by your business.b. CorporationDefinition: A corporation is a business structure that is a separate legal entity from its owners. No personal liability for the debts or obligations of the company is assumed by the owners (shareholders)—their liability remains limited to the value of their investments.c. PartnershipDefinition: A partnership is a business relationship between 2 or more people together with a view to a profit, where profits and losses are shared based on a partnership agreement, written or otherwise.

4. Is your business Federally regulated or Provincially regulated?

FederallyProvinciallyDon't know

5. Are you an essential workplace as defined by the Government of Ontario? https://www.ontario.ca/page/list-essential-workplaces

YesNo

6. Do you have:

a. EmployeesDefinition: Generally, a person is an employee if: They work full time for 1 person or company The employer deducts source deductions The employer gives them a T4 at tax time The employer controls hours of work, location, provides the tools of the trade, dictates the manner in which a job is completed.b. Independent contractorsDefinition: Generally, a person is an independent contractor if some or all of the following applies: Work for multiple employers They set their own hours Provide their own equipment to complete tasks contracted for Can write off their expenses against their income Remit their own source deductionsc. Bothd. Unsure

7. Have you terminated your employees or are you considering terminating your employees?

YesNo

a. Employee's name who you have or considering terminating:

b. How many years has the employee worked for you?

c. What was their job title?

d. Did they do job specific training while employed with you?

YesNo

e. Did they have people reporting to them in their job?

YesNo

f. Did they have the authority to hire or fire people in their jobs?

YesNo

Add/Remove additional employees

8. Have you laid off your employees or are you considering laying off your employees?

YesNo

a. Employee's name who you have or considering laying off:

b. How many years has the employee worked for you?

c. What was their job title?

d. Did they do job specific training while employed with you?

YesNo

e. Did they have people reporting to them in their job?

YesNo

f. Did they have the authority to hire or fire people in their jobs?

YesNo

Add/Remove additional employees

9. Have you significantly reduced employee hours or are you considering significantly reducing employee hours?

YesNo

a. Employee's name who you have or considering laying off:

b. How many years has the employee worked for you?

c. What was their job title?

d. Did they do job specific training while employed with you?

YesNo

e. Did they have people reporting to them in their job?

YesNo

f. Did they have the authority to hire or fire people in their jobs?

YesNo

Add/Remove additional employees

10. Do you have a written employment contract with your employees?

YesNo

a. Does it contain termination provisions?YesNoDon't Know

b. Does it contain layoff provisions?YesNoDon't Know

11. Can your employees work remotely?

YesNo

12. Have you experienced a 15% decrease in gross revenue?This means a 15% of gross revenue compared to either the same month last year i.e. March 2019 gross revenue compared to March 2020 gross revenue, or March 2020 gross revenue when compared to the average gross revenue of January and February 2020.

YesNo

13. Have you been forced to close your business as a result of COVID-19?

YesNo

14. Do you have existing bank financing?e.g. mortgage, line of credit, loan, car loan, credit card.

YesNo

15. Is your total annual payroll greater than 2.5 million?

YesNo

16. Have you terminated, laid off or reduced the hours for 50% or more of your employees?

TerminatedLaid offReduced the hours

Employee

2. Employer Name:

3. Are you a unionized employee?

YesNo

4. Have you been terminated, laid off or had significant hourly reduction?

TerminatedLaid offSignificant hourly reduction

a: How many years have you worked for your employer?

b: What was your job title?

c: Did you do specific training while employed with your current employer?

YesNo

d: Did you have people reporting to you in your job?

YesNo

e: Did you have the authority to hire or fire people in your job?

YesNo

5. Are you an:

a. EmployeeDefinition: Generally, a person is an employee if: They work full time for 1 person or company The employer deducts source deductions The employer gives them a T4 at tax time The employer controls hours of work, location, provides the tools of the trade, dictates the manner in which a job is completed.b. Independent contractorDefinition: Generally, a person is an independent contractor if some or all of the following applies: Work for multiple employers They set their own hours Provide their own equipment to complete tasks contracted for Can write off their expenses against their income Remit their own source deductions

6. Is your employer Federally regulated or Provincially regulated?

FederallyProvinciallyDon't know

7. Do you have a written employment contract?

YesNo

a. Does your contract include a layoff clause?

YesNoDon't know

b. Does your contract include a termination clause?

YesNoDon't know

8. Have you been laid off by this employer in the past?

YesNo

9. Have you stopped working because of COVID-19 and have not voluntarily quit your job?

YesNo

10. Can you work remotely?

YesNo

11. Do you have existing bank financing? e.g. mortgage, line of credit, loan, car loan, credit card.

YesNo



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