Welcome and Congratulations on your new job! We are excited to have you join the MEDA Limited team. We look forward to sharing in your future successes.
section: Benefit Enrollment
Chambers Plan - Employee Benefit
EMPLOYMENT INFORMATION (TO BE COMPLETED BY THE EMPLOYER IN INK)
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I certify this employee has been employed full-time continuously since the date shown and is now working at least 20 hours per week.
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EMPLOYEE INFO
Direct Deposit
By completing the banking information below, I authorize the Chambers of Commerce Group Insurance Plan to deposit my health and/or dental benefit payments into this account.
List all your dependents
including your spouse: (required for coverages such as Dependent Life, Health and Dental)
| First Name | Last Name | Birthdate | Sex | Full-Time Student (age 21-25) | Disabled Dependent (age 21 or over) |
Spouse | | | | | | |
Child | | | | | | |
Child | | | | | | |
Child | | | | | | |
NOTE: To decline Extended Health and/or Dental for yourself or your dependents, fill out this section. Otherwise, please leave blank.
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You may waive Extended Health and/or Dental benefits for yourself and/or your dependents
only if covered for similar benefits under another plan.
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If you have WAIVED any benefits, you must provide Coordination of Benefits information.
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Coordination of Benefits
Spouse has other coverage: |
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Beneficiary Designation:
I hereby name the following beneficiary of any Life Insurance benefits payable as a result of my participation in this plan.
Last Name | First Name and Initial | % of Benefit | Relationship to Employee | Birthdate |
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Trustee/Administrator Designation:
If the beneficiary is under the age of majority, I appoint the trustee/administrator named below to receive any amount payable to a minor
beneficiary under this policy. The trustee/administrator shall discharge the Insurer for the amount paid. I authorize the trustee/administrator to spend all or part of the amount, or
interest earned on it, for the support or education of the minor.
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If you are designating a trustee/administrator, you should consult with a legal advisor and any proposed trustee/administrator.
For Quebec Only: The appointment will be interpreted in accordance with provisions governing the administration of property of others, under Quebec Civil Code.
Sirius Benefit Member Application
1 Member Info
2 Other Coverage
Only complete this section if you have a spouse. |
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3 Dependent Info
| First Name | Last Name | Birthdate | Sex | Full-Time Student (age 21-25) | Disabled Dependent (age 21 or over) |
Spouse | | | | | | |
Child | | | | | | |
Child | | | | | | |
Child | | | | | | |
Child | | | | | | |
4 Beneficiary
Last Name | First Name | Relationship to Member | Percentage (cannot exceed 100% in total) |
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Trustee Designation
This section is to be completed only if the beneficiary
designated above is under the age of majority
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5.
I consent to the collecting, using and disclosing of my personal information for the purposes of communication, underwriting risks, investigating and adjudicating
claims, detecting and preventing fraud, compiling statistics and acting as required or authorized by law. I certify that all information in this form is true and accurate. I
hereby apply for coverage for which I am, or may become, eligible for. I acknowledge that I only enroll, at this time or any future time, dependents that have
authorized me to provide their information and consent to the collection, use and disclosure of their information for the above purposes. I authorize Sirius Benefit
Plans, any insurance companies and healthcare providers to exchange information when necessary to determine eligibility and to administer the plan.
I designate the above mentioned beneficiary for any benefits payable as a result of my participation in this plan.
EMPLOYMENT INFORMATION (TO BE COMPLETED BY THE EMPLOYER IN INK)
Chambers Plan - Beneficiary Designation
PRIMARY DESIGNATION
I hereby name the following beneficiary(ies) of any Life Insurance benefits payable as a result of my participation in this plan.
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Last Name | First Name | % of Benefit | Relationship to Employee | Birthdate |
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Trustee/Administrator Designation:
If the beneficiary is under the age of majority, I appoint the trustee/administrator named below to receive any amount
payable to a minor beneficiary under this policy. The trustee/administrator shall discharge the Insurer for the amount paid. I authorize the trustee/administrator to
spend all or part of the amount, or interest earned on it, for the support or education of the minor.
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If you are designating a trustee/administrator, you should consult with a legal advisor and any proposed trustee/administrator. For Quebec Only: The appointment
will be interpreted in accordance with provisions governing the administration of property of others, under Quebec Civil Code.
CONTINGENT DESIGNATION
You may wish to designate a contingent beneficiary(ies) to receive any proceeds under this group policy if all of the primary beneficiary(ies), named above, should
die before you. In that event, a contingent beneficiary will automatically be entitled to the benefit that would have been payable to the primary beneficiary(ies).
Should there not be any surviving beneficiary(ies) at the time of your death, the proceeds will be paid to your estate.
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Last Name | First Name | % of Benefit | Relationship to Employee | Birthdate |
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Trustee/Administrator Designation:
If the beneficiary is under the age of majority, I appoint the trustee/administrator named below to receive any amount
payable to a minor beneficiary under this policy. The trustee/administrator shall discharge the Insurer for the amount paid. I authorize the trustee/administrator to
spend all or part of the amount, or interest earned on it, for the support or education of the minor.
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If you are designating a trustee/administrator, you should consult with a legal advisor and any proposed trustee/administrator. For Quebec Only: The appointment
will be interpreted in accordance with provisions governing the administration of property of others, under Quebec Civil Code.
Declaration and Authorization for the Collection and Communication of Personal Information
All the information I have provided on the form is accurate and complete, to the best of my knowledge.
I authorize Chambers of Commerce Group Insurance Plan to collect, use, maintain and disclose personal information relevant to this application for the purposes
of benefit plan administration, assessment, investigation, claim management, underwriting and for determining Plan eligibility. The non-exhaustive list of sources
from which information can be collected includes medical and health professionals, facilities or providers, insurance companies, or other organizations/persons.
This authorization is also valid for the collection, use and communication of personal information concerning my dependents, insofar as applicable to the
administration of benefits under this plan.
I acknowledge that more specific information about collection and use of my personal information can be found in the Privacy Policy on
www.chamberplan.ca or
from the administrator of my benefit program. A photocopy of this authorization is as valid as the original.
Email and Fax Authorization Request
AUTHORIZATION TO EMAIL OR FAX PERSONAL MEDICAL INFORMATION
I authorize the Chambers of Commerce Group Insurance Plan to email or fax a copy of any requests for additional medical information and/or questionnaires
required to process any application for coverage under this plan, including any correspondence relating to a medical underwriting decision. This authorization
extends to my dependents, if applicable. A photocopy of this authorization is as valid as the original.
DECLARATION AND AUTHORIZATION FOR THE COLLECTION AND COMMUNICATION OF PERSONAL INFORMATION
All the information I have provided on the form is accurate and complete, to the best of my knowledge.
I authorize Chambers of Commerce Group Insurance Plan to collect, use, maintain and disclose personal information relevant to this application for the purposes of
benefit plan administration, assessment, investigation, claim management, underwriting and for determining Plan eligibility. The non-exhaustive list of sources from
which information can be collected includes medical and health professionals, facilities or providers, insurance companies, or other organizations/persons. This
authorization is also valid for the collection, use and communication of personal information concerning my dependents, insofar as applicable to the administration
of benefits under this plan.
I acknowledge that more specific information about collection and use of my personal information can be found in the Privacy Policy on
www.chamberplan.ca or
from the administrator of my benefit program. A photocopy of this authorization is as valid as the original.
section: Direct Deposit
Direct Deposit Authorization Form
Please email your void cheque or bank authorization form
to your account manager or payroll at
I (we) hereby authorize MEDA Limited to deposit directly to my (our) account as noted on the void cheque or bank authorization form emailed to my account manager or payroll (payroll@medagroup.com) beginning
This authorization will be in force until notice in writing is given to stop the direct deposit.
section: Timesheet & Vacation
TIMESHEETS
A FEW IMPORTANT POINTS:
- Since our payroll function is carried out electronically through direct deposit, it is mandatory that we receive timesheets no later than 12:00 noon every Monday. This will help ensure that payroll is completed accurately and on time.
- If you work on a public holiday (See list below), you are entitled to be paid time-and-a-half for those hours. Please put these hours in the “overtime” section of your timesheet for the appropriate day. You are also entitled to holiday pay as outlined in the Ontario Employment Standards Act.
- If you do not work on a statutory holiday, simply enter “H” in the appropriate box on your timesheet.
- If you work on a Client specific holiday, please consult with your MEDA supervisor to see if you are entitled to time-and-a-half for these hours since these arrangements may differ within and between companies.
- It is important that you ensure your regular and overtime hours accurately reflect what you are owed before your timesheet is submitted to the MEDA Limited office, and it has been approved by your Supervisor.
- We are always available to answer any questions you may have. Please call if we can be of help.
Ontario Public Holidays
New Year’s Day | Family Day | Good Friday |
Victoria Day | Canada Day | Labour Day |
Thanksgiving Day | Christmas Day | Boxing Day |
I have read and understand the above document
I have read and understand the above document
Timesheet Examples
Download
Timesheet Examples
I have read and understand the above document
section: Vacation/Leave Request Form
I have read and understand the above document
section: Agreement to Work Excess Hours
AGREEMENT TO WORK EXCESS HOURS
BETWEEN
MEDA Limited
&
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I agree to work excess hours (exceeding 8 hours in a day or 48 hours in a week) while employed with MEDA Limited. I agree to inform MEDA Limited if required to perform overtime. I understand that I may terminate this agreement at any time by informing MEDA Limited. I have read and understand the
“Information for Employees about Hours of Work and Overtime” (See link). I have also read and understand that in its entirety, this agreement is between myself and MEDA Limited.
This agreement expires at the end of your current employment contract.
section: Telecommunication Policy
Telecommuting Policy
Intent
The purpose of this policy is to define the responsibilities of the employee and MEDA (MEDA Limited) as it relates to Telecommuting. Telecommuting for this policy is defined as any work performed by a MEDA employee away from the employee’s regularly assigned work location. Employee includes all employees and subcontractors working for MEDA regardless of where they are assigned.
Policy
- Telecommuting includes all aspects of performing work for MEDA away from the employee’s regularly assigned work location (office, factory, etc.)
- Telecommuting can only be at the recommendation of the employee’s supervisor. All telecommuting must be approved in writing (email correspondence is an acceptable form of writing for this policy) prior to commencing. A copy of the approval for telecommuting must be made available to MEDA’s HR Department.
- Any telecommuting arrangement may be discontinued, at will and at any time at the request of MEDA (or MEDA’s client).
- Equipment supplied by MEDA or MEDA’s Client is the responsibility of the employee as per our Company Equipment Terms and Conditions Policy.
- Any equipment used that is supplied to the employee must be maintained by the employee. Employee is solely responsible for any damages personal use may cause. It is solely the employee’s responsibility to ensure that equipment used by the employee is free of viruses or anything that may cause damage to MEDA or MEDA’s Clients property.
- MEDA will not be liable for damages to the employee's property resulting from participation in telecommuting. In signing this document, employee agrees to hold MEDA harmless against any and all claims, excluding WSIB claims. Employee accepts responsibility for maintaining the security, condition, and confidentiality of MEDA’s and MEDA Client’s equipment and materials (including but not limited to files, applications, manuals, forms) that are at the remote workplace.
- Employee’s use of personal equipment while Telecommuting is at the sole discretion of the Employee.
- MEDA or MEDA’s Client reserves the right to make determinations as to appropriate equipment (including software), subject to change at any time.
- Equipment supplied by MEDA is to be used for business purposes only. An inventory of MEDA or Client assets used for Telecommuting must be signed off on by employee and provided to MEDA HR.
- Upon termination of employment all MEDA or Client company property will be returned to MEDA.
- Consistent with MEDA’s expectations of information security, employees Telecommuting are required to ensure the protection of proprietary MEDA and/or MEDA’s Client information accessible while Telecommuting. Steps include use of locked file cabinets and desks, regular password maintenance, and any other steps appropriate for the job and the environment. Employee will establish an appropriate work environment within his or her home for work purposes.
- MEDA will not be responsible for costs associated setup or maintenance of the employee’s home office.
- It is employee’s responsibility who access MEDA’s or MEDA’s Client’s work via a remote location to ensure that they log out of their work when finished, at all times and without exception.
- Employees of MEDA are prohibited from saving remote access passwords to personal computers.
- At no time should any MEDA employee provide his/her remote access login or password to anyone, not even family members.
- All work emails sent from employee owned devices must adhere to MEDA Email Policy and Procedures.
- All company records, files, and documents must be protected from unauthorized disclosure or damage and returned safely to the primary workplace. When telecommuting each employee agrees to abide by MEDA’s policy concerning the use of computer equipment (which may include protecting the employee’s home computer against computer “viruses”), and understands that these rules may be changed at any time with proper notice. The employee agrees to follow MEDA’ s procedures for network access and to take all necessary steps to protect the integrity of systems including but not limited to: protecting passwords, not duplicating company-owned software, and not allowing company files to be viewed by others.
- No employee engaged in telecommuting will be allowed to conduct face-to-face company-related business at their home. In signing this agreement, the employee verifies that the employee’s home is free of safety and fire hazards.
Acknowledgement & Agreement
I
acknowledge that I have read and understand the Telecommuting Policy of MEDA. I agree to adhere to this policy and will ensure that employees working under my direction adhere to this Policy. I understand that if I violate the rules set forth in this Policy, I may face disciplinary action, up to and including termination of employment.
section: MEDA Employee Handbook
MEDA Canadian Handbook
Download
MEDA Canadian Handbook
Acknowledgement and Receipt of Employee Handbook
I have received my copy of the Employee Handbook.
The employee handbook describes important information about MEDA Engineering and Technical Services, LLC (MEDA) and I understand that I should consult with Human Resources, my direct MEDA manager, or the President regarding any questions not answered in the handbook.
I understand that this employee handbook is intended as a guide and the language is not intended to create, nor is it to be construed to constitute, a contract or guarantee of continued employment between MEDA. This employee handbook does not cover every situation that might arise during my employment but is a general guide to the goals, policies, benefits, and expectations of MEDA.
This employee handbook and the policies and procedures contained herein supersede any prior practices, oral or written representations, or statements regarding the terms and conditions of your employment with MEDA. By distributing this handbook, the Company expressly revokes all previous policies and procedures which are inconsistent with those contained herein.
All policies and practices may be changed at any time by MEDA. All such changes will be communicated through official notices, and I understand that revised information may supersede, modify, or eliminate existing policies. Only the President of the organization has the ability to adopt any revisions to the policies in this handbook.
Furthermore, I understand that it is my responsibility to read and comply with the policies contained in this handbook and any revisions made to it.
section: New Hire Emergency Info
New Hire – Emergency Contact Information
In case of an emergency, please notify:
section: Employment Standards & Rights
Employment Standards in Ontario
Download
Employment Standards in Ontario
I have read and understand the above document
Your Employment Standard Rights
Download
Your Employment Standard Rights
I have read and understand the above document
section: WHIMIS & Health Safety
WHMIS 2015 AND THE GHS
Download
WHMIS 2015 AND THE GHS
I have read and understand the above document
WHMIS 2015 AND THE GHS TEST
I have completed this quiz without the help of others
section: Worker Health and Safety Awareness in 4 Steps
Worker Health and Safety Awareness in 4 Steps
Download
Worker Health and Safety Awareness in 4 Steps
I have read and understand the above document
Step 1: Get On Board Quiz
Step 2: Get in the Know Quiz
Step 3: Get Involved Quiz
Step 4: Get More Help Quiz
section: Accessible Customer Service
Accessibility Standards for Customer Service Policy
Download
Accessibility Standards for Customer Service Policy
I have read and understand the above document
section: AODA Quiz
AODA Quiz
External SIGN-UP CHECKLIST
Payroll Information
Health & Safety
Thank you!