Verification of Employment

Employee Information

First Name Last Name

Start Date (DD-MM-YYYY) Length of Employment

Please describe the scope of practice and duties performed by the employee:

Employer Contact Information

Company Name of Employer City & Country of Employment Location

First Name Last Name

Title Telephone Number

Email Relationship to Employee

Signature Date (DD-MM-YYYY)

The Employer must submit directly to COPR: assessment@copr.ca