Information:

Province of employment: Manitoba

Employer: Diverse Enterprises Inc.

123 Street.

Winnipeg, Manitoba, R2R 2R2

Employer RCT No.: 102 345 678 RP0001

Employee Name: Linda Buckley

420 Ash St

Wpg, MB R3R 1C1

Position: Technician

Birth Date: August 21, 1992

SIN: 627-673-327

Pay method: Salary

Pay frequency: Bi-weekly

Number of hours worked per pay period 80/8 hours per day

Pay rate: $42,000 annually

Start Date: March 20, 2021

Termination Date: September 1, 2021

Last pay period ending date: September 9, 2021

Miscellaneous deductions:

Extended Health Benefits $10.00 per pay

Dental premium $14.00 per pay

Registered Co. Pension Plan 1.6% of gross pay per pay

Additional information:

• Monthly downtown parking fees of $63.00 (includes GST) are paid by the employer and a prorated taxable benefit is included on each pay.

• Diverse Enterprises was closed for the Civic Holiday in August and all salaried employees were paid for their regular hours/pay for the day.

• Employees at Diverse work a Monday to Friday work week.

• Linda Buckley is married and is supporting her husband who currently has no income. Linda claims her spouse on both her TD1 forms.

• Lindas final pay included her vacation pay and regular pay

Can anyone please help me to fill out the ROE form?

IT Service If completing this form by hand: use a pen Canada EMPLOYER: SEE THE GUIDE - HOW TO COMPLETE THE RECORD OF EMPLOYMENT, IT IS Protected when RECORD OF EMPLOYMENT (ROE) ALSO AVAILABLE ON THE WEB SITE AT: WWW.SERVICECANADA.GC.CA completed - B SERIAL NO. 2 SERIAL NO. OF ROE AMENDED OR REPLACED 3 EMPLOYER'S PAYROLL REFERENCE NO. E0000000 EMPLOYER'S NAME AND ADDRESS CRA'S BUSINESS NO. (BN) ENTER CODE PAY PERIOD TYPE A SHORTAGE OF WORK POSTAL CODE & SOCIAL INSURANCE NO. B STRIKE OR LOCKOUT EMPLOYEE'S NAME AND ADDRESS D M Y 7 10 FIRST DAY WORKED (OR FIRST DAY WORKED SINCE LAST ROE ISSUED) 11 LAST DAY FOR WHICH PAID C RETURN TO SCHOOL D M Y D D ILLNESS OR INJURY 12 D M Y FINAL PAY PERIOD ENDING DATE L 13 OCCUPATION E QUIT D 14. EXPECTED DATE OF RECALL NKNOWN NOT RETURNING M Y O 15A F MATERNITY TOTAL INSURABLE HOURS ACCORDING TO CHART ON REVERSE REASON FOR ISSUING THIS ROE ENTER CODE G RETIREMENT 158 TOTAL INSURABLE EARNINGS ACCORDING TO CHART ON REVERSE FOR FURTHER INFORMATION, CONTACT $ TELEPHONE NO. ( ) H WORK SHARING 15C ONLY COMPLETE IF THERE HAS BEEN A PAY PERIOD WITH NO INSURABLE EARNINGS, COMPLETE ACCORDING TO CHART ON REVERSE P.P. INSURABLE EARNINGS P.P INSURABLE EARNINGS P.P. INSURABLE EARNINGS 1 2 3 17 ONLY COMPLETE IF PAYMENTS OR BENEFITS Edit Now PAID IN OR IN ANTICIPATION OF THE FINAL PA LATER DATE A - VACATION PAY B - STATUTORY HOLIDAY PAY FOR M $ $ Do Not Show Again FREKVICE TRAINING D 4 5 6 $ M DISMISSAL . 7 8 9 $ N LEAVE OF ABSENCE 10 11 12 C-OTHER MONIES (SPECIFY) 13 14 15 $ P PARENTAL 16 17 18 $ 19 20 21 $ Q Z COMPASSIONATE CARE 22 23 24 18 COMMENTS 25 26 27 19 ONLY COMPLETE IF PAID SICK/MATERNITY/PARENTAL LEAVE OR GROUP WAGE LOSS INDEMNITY PAYMENT (AFTER THE LAST DAY WORKED). K OTHER EXPLAIN IN THE COMMENTS SECTION O O PAYMENT START DATE AMOUNT D M Y $ PER DAY PER WEEK COMMUNICATION PREFERRED IN 21 TELEPHONE NO. D ENGLISH FRENCH 22 I AM AWARE THAT IT IS AN OFFENCE TO MAKE FALSE ENTRIES AND HEREBY CERTIFY THAT ALL STATEMENTS ON THIS FORM ARE TRUE. E2A T3 BATHURSS000 SERVICE CANADA 2 (BLUE) MUST BE SENT TO D M Y Canada L SIGNATURE OF ISSUER NAME OF ISSUER (please print) Service Canada delivers Human Resources and Skills Development Canada programs and services for the Government of Canada. DATE EMPLOYEE'S COPY *(See reverse) PART 1 Formulaire disponible en franais. L IT Service If completing this form by hand: use a pen Canada EMPLOYER: SEE THE GUIDE - HOW TO COMPLETE THE RECORD OF EMPLOYMENT, IT IS Protected when RECORD OF EMPLOYMENT (ROE) ALSO AVAILABLE ON THE WEB SITE AT: WWW.SERVICECANADA.GC.CA completed - B SERIAL NO. 2 SERIAL NO. OF ROE AMENDED OR REPLACED 3 EMPLOYER'S PAYROLL REFERENCE NO. E0000000 EMPLOYER'S NAME AND ADDRESS CRA'S BUSINESS NO. (BN) ENTER CODE PAY PERIOD TYPE A SHORTAGE OF WORK POSTAL CODE & SOCIAL INSURANCE NO. B STRIKE OR LOCKOUT EMPLOYEE'S NAME AND ADDRESS D M Y 7 10 FIRST DAY WORKED (OR FIRST DAY WORKED SINCE LAST ROE ISSUED) 11 LAST DAY FOR WHICH PAID C RETURN TO SCHOOL D M Y D D ILLNESS OR INJURY 12 D M Y FINAL PAY PERIOD ENDING DATE L 13 OCCUPATION E QUIT D 14. EXPECTED DATE OF RECALL NKNOWN NOT RETURNING M Y O 15A F MATERNITY TOTAL INSURABLE HOURS ACCORDING TO CHART ON REVERSE REASON FOR ISSUING THIS ROE ENTER CODE G RETIREMENT 158 TOTAL INSURABLE EARNINGS ACCORDING TO CHART ON REVERSE FOR FURTHER INFORMATION, CONTACT $ TELEPHONE NO. ( ) H WORK SHARING 15C ONLY COMPLETE IF THERE HAS BEEN A PAY PERIOD WITH NO INSURABLE EARNINGS, COMPLETE ACCORDING TO CHART ON REVERSE P.P. INSURABLE EARNINGS P.P INSURABLE EARNINGS P.P. INSURABLE EARNINGS 1 2 3 17 ONLY COMPLETE IF PAYMENTS OR BENEFITS Edit Now PAID IN OR IN ANTICIPATION OF THE FINAL PA LATER DATE A - VACATION PAY B - STATUTORY HOLIDAY PAY FOR M $ $ Do Not Show Again FREKVICE TRAINING D 4 5 6 $ M DISMISSAL . 7 8 9 $ N LEAVE OF ABSENCE 10 11 12 C-OTHER MONIES (SPECIFY) 13 14 15 $ P PARENTAL 16 17 18 $ 19 20 21 $ Q Z COMPASSIONATE CARE 22 23 24 18 COMMENTS 25 26 27 19 ONLY COMPLETE IF PAID SICK/MATERNITY/PARENTAL LEAVE OR GROUP WAGE LOSS INDEMNITY PAYMENT (AFTER THE LAST DAY WORKED). K OTHER EXPLAIN IN THE COMMENTS SECTION O O PAYMENT START DATE AMOUNT D M Y $ PER DAY PER WEEK COMMUNICATION PREFERRED IN 21 TELEPHONE NO. D ENGLISH FRENCH 22 I AM AWARE THAT IT IS AN OFFENCE TO MAKE FALSE ENTRIES AND HEREBY CERTIFY THAT ALL STATEMENTS ON THIS FORM ARE TRUE. E2A T3 BATHURSS000 SERVICE CANADA 2 (BLUE) MUST BE SENT TO D M Y Canada L SIGNATURE OF ISSUER NAME OF ISSUER (please print) Service Canada delivers Human Resources and Skills Development Canada programs and services for the Government of Canada. DATE EMPLOYEE'S COPY *(See reverse) PART 1 Formulaire disponible en franais. L