Information on incumbent employees: PWGSC-TPSGC 5116

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Information on incumbent employees [PDF - 484 KB]

Appendix

NOTE: This form is to be used with respect to the Successor Employer provisions of the contract.

1. Company name:

2. Address:

3. Tel. No.(999-999-9999):

4. Fax No.(999-999-9999):

5. Workplace address:

6. Contract No.:

List below all your employees working at this workplace and give each employee, in box 7, a separate number. If more space is required for any of these items, attach additional pages and make reference to the employees' separate number and to the item number.

7. Employee name:

No.:

8. Address:

9. Tel. No.(999-999-9999):

10. Date of hire (YYYY-MM-DD):

11. Period of employment

From (YYYY-MM-DD):

To (YYYY-MM-DD):

12. Wage rates :

13. Cost and period of each benefit :
Date (YYYY-MM-DD):

14. Job classification or description:

15. Number of weeks worked at premises during the 26 weeks preceding the date of request for information.

16. Number of hours worked in regular non-overtime work week.

17. If hours of work vary from week to week, number of non-overtime hours for each week worked during the 13 weeks preceding the request for information.

Week 1:

Week 2:

Week 3:

Week 4:

Week 5:

Week 6:

Week 7:

Week 8:

Week 9:

Week 10:

Week 11:

Week 12:

Week 13:

18. Statement (check as applicable):

the employee is actively employed at the premises but his/her job duties were not primarily performed at the premises during the 13 weeks preceding the date of request for information;
the employee is employed but not actively employed at the premises, but his/her job duties were not primarily performed at the premises during his/her most recent 13 weeks of active employment.

19. If applicable, check one of the boxes:

Copy of collective agreement attached.

Copy of union certificate attached.

Copy of pending union application(s) attached.

20. Information provided on this form is:

Original

Revised

Dated (YYYY-MM-DD):

21. Name of authorized company representative:

Signature: _______________________________

Date (YYYY-MM-DD) 2:

PWGSC
Bidder(s)
Successful Bidder
Current Contrator

From:

Public Services and Procurement Canada

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2026-01-29

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Information on incumbent employees: PWGSC-TPSGC 5116

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