THE GUIDE - HOW TO COMPLETE THE RECORD OF EMPLOYMENT,
PROVIDES DETAILED INSTRUCTIONS.
Protected when completed - B
RECORD OF EMPLOYMENT (ROE)
1 SERIAL NO. 2 SERIAL NO. OF ROE AMENDED OR REPLACED 3 EMPLOYER'S PAYROLL REFERENCE NO.
M03652819 396949
4 EMPLOYER'S NAME AND ADDRESS 5 CRA PAYROLL ACCOUNT NUMBER
DRAKE INTERNATIONAL INC OFFICE OVERLOAD 101480655RP0002
PO BOX 800 STN F 6 PAY PERIOD TYPE
W - Weekly
TORONTO ON 7 POSTAL CODE 8 SOCIAL INSURANCE NO.
Canada M4Y2N8 693-447-971
9 EMPLOYEE'S NAME AND ADDRESS 10 FIRST DAY WORKED D M Y
Abdihafid Moha Abdullahi 17 08 2023
103 11008 83ST 103 11008 83ST 11 LAST DAY FOR WHICH PAID D M Y
EDMONTON T5H1M3 22 08 2023
AB, CA 12 FINAL PAY PERIOD ENDING DATE D M Y
26 08 2023
13 OCCUPATION 14 EXPECTED DATE OF RECALL D M Y
General Labor - Edmonton Winspear UNKNOWN NOT RETURNING
X
15A TOTAL INSURABLE HOURS 16 REASON FOR ISSUING THIS ROE
ACCORDING TO CHART ON PAGE 2 42
Shortage of work / End of contract or season A
15B TOTAL INSURABLE EARNINGS FOR FURTHER INFORMATION, CONTACT
ACCORDING TO CHART ON PAGE 2 PAYROLL DEPARTMENT
$ 790.40
TELEPHONE NO. (780) 414-6341
15C THE FIRST ENTRY MUST RECORD THE INSURABLE EARNINGS FOR THE 17 ONLY COMPLETE IF PAYMENT OR BENEFITS (OTHER THAN REGULAR PAY) PAID IN OR IN
FINAL (MOST RECENT) INSURED PAY PERIOD. ENTER DETAILS BY PAY ANTICIPATION OF THE FINAL PAY PERIOD OR PAYABLE AT A LATER DATE.
PERIOD AS PER THE CHART ON PAGE 2. A - VACATION PAY
INSURABLE INSURABLE INSURABLE
Included with each pay $
P.P. P.P. P.P.
EARNINGS EARNINGS EARNINGS
START DATE (D/M/Y): END DATE (D/M/Y):
1 316.16 2 474.24 3
B - STATUTORY HOLIDAY PAY FOR
4 5 6 D M Y D M Y
7 8 9
$ $
$ $
10 11 12
$ $
13 14 15 $ $
16 17 18 $ $
C - OTHER MONIES (SPECIFY)
19 20 21
22 23 24 $
25 26 27 START DATE (D/M/Y): END DATE (D/M/Y):
28 29 30
$
31 32 33
START DATE (D/M/Y): END DATE (D/M/Y):
34 35 36
$
37 38 39
START DATE (D/M/Y): END DATE (D/M/Y):
40 41 42
19 PAID SICK/MATERNITY/PARENTAL/COMPASSIONATE CARE/FAMILY CAREGIVER LEAVE
43 44 45 OR GROUP WAGE LOSS INDEMNITY PAYMENT
START DATE END DATE AMOUNT PER PER
46 47 48 D M Y D M Y DAY WEEK
PSL $
49 50 51
WLI - Not ins. $
52 53
WLI - Ins. $
18 COMMENTS MAT/PAR/CC/FC $
20 COMMUNICATION PREFERRED IN 21 TELEPHONE NO.
X English French (416) 216-1059
22 I AM AWARE THAT IT IS AN OFFENSE TO KNOWINGLY MAKE FALSE ENTRIES AND
HEREBY CERTIFY THAT ALL STATEMENTS ON THIS FORM ARE TRUE.
Name of Issuer
Eda D M Y
Thomas 15 11 2023
INS 5220 (12-17) E Service Canada delivers Employment and Social Development Canada programs and services for the Government of Canada.
Version 12.6.0
Service Canada has already received a copy of this electronic Record of Employment. Do not submit a paper copy of this Record of Employment to Service Canada.
Page 2 contains important information. Ce formulaire est également disponible en français
Important Information and Instructions for Employees
What is a Record of Employment?
The Record of Employment (ROE) is a form your employer must complete when you stop working. Your employer has to issue the ROE to you, even if
you do not intend to apply for EI benefits. On the ROE, you will find details about your work history with your employer. You do not need your ROEs to
apply for EI benefits. If you delay filing your EI claim for more than four weeks after you stop working, you may lose benefits.
How do I apply for EI benefits?
You can apply for EI benefits online at www.servicecanada.ca or by visiting your nearest Service Canada Centre.
To find the location of your nearest Centre, click on “Contact Us” on the Web site or call 1 800 O-Canada (1-800-622-6232).
What do I do with my ROEs?
After you submit your EI application online, you will need to provide us with any paper ROEs issued to you during the last 52 weeks. We cannot process
your application until we receive them. For this reason, you must submit your paper ROEs as soon as possible after you submit your EI application.
You can either mail us your paper ROEs (the address is provided when you apply for EI online - if you need the address, call us at 1-800-206-7218
(TTY: 1-800-529-3742)) or drop them off in person at a Service Canada Centre.
This ROE was submitted electronically by your employer to Service Canada. For this reason, you do not need to provide us with a copy of it. For copies
of all ROEs in your name that have been submitted electronically, visit My Service Canada Account on the Canada Web site at www.canada.ca.
What if I’m not planning to apply for EI benefits?
If you are not applying for EI benefits, keep this and all other ROEs in a safe place for two years after the date shown in Block 11.
What do I do if the information on the ROE is incorrect?
If any information on this form appears to be incorrect, talk with your employer right away to correct or clarify it. Do not make any changes yourself.
What does the information in Blocks 15A, 15B, and 15C mean?
· Block 15A, Total insurable hours: The number in Block 15A represents the total insurable hours you worked in a certain number of pay periods.
See the chart below for the number of pay periods your employer has included, based on your pay period type.
· Block 15B, Total insurable earnings: The amount in Block 15B represents the total insurable earnings you received over a certain number of pay
periods. See the chart below for the number of pay periods your employer has included, based on your pay period type.
· Block 15C, Breakdown of insurable earnings by pay period: In this block, your employer has broken down your insurable earnings by pay
period. Line PP1 in Block 15C shows the insurable earnings for your final (most recent) pay period. For pay periods with no insurable earnings,
your employer will have entered “0” (zero).
Information included in Blocks 15A, 15B, and 15C
Pay period type Number of consecutive pay periods Number of consecutive pay periods Number of consecutive pay periods
(Block 6) to report for total insurable hours to report for insurable earnings to report for insurable earnings
(Block 15A) (Block 15B) (Block 15C)
Weekly Last 53 pay periods* Last 27 pay periods* Last 53 pay periods*
Bi-weekly Last 27 pay periods* Last 14 pay periods* Last 27 pay periods*
Semi-monthly Last 25 pay periods* Last 13 pay periods* Last 25 pay periods*
Monthly Last 13 pay periods* Last 7 pay periods* Last 13 pay periods*
13 pay periods per year Last 14 pay periods* Last 7 pay periods* Last 14 pay periods*
*Or fewer, if the period of employment was shorter.
What does the code in Block 16 mean?
The following chart explains the codes that may appear in Block 16:
A – Shortage of work / End of contract or season B – Strike or lockout D – Illness or injury
E – Quit F – Maternity G – Mandatory retirement
H – Work-Sharing J – Apprentice training M – Dismissal or suspension
N – Leave of absence P – Parental Z – Compassionate care/Family caregiver
K – Other (see Block 18, Comments)
What happens if I receive benefits to which I am not entitled?
If for any reason you receive EI benefits to which you are not entitled, you will have to repay those benefits. Knowingly making false or misleading
statements is an offence under the law that can result in an administrative penalty or prosecution.
Note
Service Canada collects the information on this form for the purposes of administering and enforcing the Employment Insurance Act. The information is kept in Personal Information Banks ESDC PPU
150, 180, and 385, and will be used and disclosed in accordance with the conditions that apply to the Personal Information Banks. Service Canada may also use the information for policy analysis,
research, and/or evaluation purposes. To conduct these activities, Service Canada may link information under its custody and control. Any information Service Canada collects will be administered in
accordance with the Privacy Act. Under the provisions of the Privacy Act, individuals have the right to have their personal information protected, and to have full access to it. For instructions on how to
obtain your personal information, as well as a detailed description of the Personal Information Banks, see InfoSource, a publication available at Service Canada Centres or online at
www.canada.ca/infosource-ESDC.
