APPLICATION FORM

EMPLOYMENT HISTORY

List below, beginning with your most recent, the last 3 employment records:

Name of Company *

City / Province *

Supervisor *

Phone Number

Payrate

Position Held *

From *

to *

Reason for Leaving *

Duties *

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Name of Company

City / Province

Supervisor

Phone Number

Payrate

Position Held

From

to

Reason for Leaving

Duties

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Name of Company

City / Province

Supervisor

Phone Number

Payrate

Position Held

From

to

Reason for Leaving

Duties

Administration / Clerical Skills

Please check all that apply to your work experience and/or training:Commercial / RetailIndustrialManufacturingWarehouseMedicalLawReal EstateInsuranceAdobe ReaderCall CenterAccounting SoftwareReceptionistAdministrative AssistantMulti-Line SwitchboardWindowsExcelWordPowerPointOutlookAccess / OneNoteDispatchInternet SearchesCustomer ServiceData EntrySupervisoryQuickBooksPayrollHuman ResourcesAccounts PayableAccounts ReceivableInventoryBank ReconciliationAccounting (designation)Insurance (certification)Customs (certification)SchedulingGraphic DesignerManagerialMarketingSales

Typing Speed (WPM)

Certifications Other

Certifications You Possess

Release of Information Consent Form Pursuant to the Personal Information Protection and Electronic Document Act (PIPEDA)
I, (Candidate name) * authorize Modern Staffing to disclose the following health information to any of Modern Staffing's clients that I might be assigned to.
Health Information (i.e. Allergies) to be disclosed:
In Case of Emergency Contact Information
Name	Relationship	Primary Phone	Secondary Phone
Name	Relationship	Primary Phone	Secondary Phone
I understand the purpose for disclosing this personal information to the person/client noted above. Candidate name *
I understand that I can refuse to sign this consent form. I acknowledge that I have read this form and refuse to authorize MODERN Staffing to release any information. Candidate name

DIRECT DEPOSIT AUTHORIZATION FORM

I (we) hereby authorize MEDA Limited O/A MODERN Staffing to deposit directly to my (our) account as noted

on the attached cheque / deposit form, beginning

This authorization will be in force until notice in writing is given to stop the direct deposit.

Candidate Name *

Candidate Agree Date *2025-05-03

REFERENCES (please provide only working references)

Name of Supervisor	Company Name	Phone Number
Name of Supervisor	Company Name	Phone Number
Name of Supervisor	Company Name	Phone Number

Applicant’s Release (Please read Carefully) 

All information provided by me in support of my application for employment is true and correct to the best of my knowledge. I understand that misrepresentation or omissions will constitute sufficient grounds for rejection or for subsequent dismissal if I am hired. I understand that I may become aware of confidentiality information regarding the policies and procedures of MODERN Staffing. I also understand that I am expected to keep all information private and confidential and not to disclose information without direct permission. I hereby authorize any current or former employer, school, person, firm, corporation or government agency to answer any and all questions and to release or provide information within their knowledge or records, and I agree to hold any or all of them blameless and free of any liability for releasing any truthful information within their knowledge or records. MODERN Staffing is hereby authorized to release to any other firm or person with whom I may seek employment, any or all information concerning my employment or application and I agree to hold MODERN Staffing blameless and free of any liability for releasing such information.

Candidate Name (Legal First & Last Name) *

Candidate Agree Date *2025-05-03

WORKPLACE INJURIES – CONTRACT WORKERS

It is very important to follow the necessary steps when an injury has taken place.

After the injury has taken place, please adhere to the following:

Contact MODERN Staffing and advise immediately.

Obtain a FAF – Functional Ability form to bring the hospital, clinic or where ever you may be obtaining medical treatment. Obtain a copy of the FAF and bring to the office as soon as possible.

You will be meeting with Sheila Gyorgy or a member of the JH&SC to discuss the details of your injury and to discuss further actions

Please note that when you are assigned through MODERN Staffing at a MODERN Staffing client MODERN STAFFING is your employer. You may be asked this question while receiving medical treatment.

Contact Information:

All injuries need to be reported as soon as possible to MODERN Staffing.

Office: (519) 944-3675

After hour’s emergency line: (519) 796-6864

If you have any questions regarding the above memo, please feel free to call me anytime.

My goal is to provide a safe work environment for my employees and to make all efforts to prevent work place injuries.

Candidate Name *

Candidate Agree Date *2025-05-03

RETURN TO WORK POLICY

MODERN Staffing cares about our employees and their well being.

The Management team will make every effort to ensure that all employees will be given a fair customized Modified Work agreement whenever possible.

The Management team will educate and train all parties involved the purpose, importance and benefits of our Return to Work Program.

All internal employees, supervisors and JH&SC members will be trained to ensure all field employees requiring the use of our RTW program will be provided with a fair and beneficial service.

Return to Work Associate for MODERN Staffing

Sheila Gyorgy

JH&SC Management Representative

Claims Consultant/RTW Associate

Phone: (519) 944-3675

Email: sgyorgy@medagroup.com

Candidate Name *

Candidate Agree Date *2025-05-03

EMPLOYMENT POLICY

The following agreement represents MODERN Staffing’s employment policy. This does not represent an employment contract. The employment agreement will be mailed to you upon acceptance of an assignment through MODERN Staffing at a Client of MODERN Staffing.

1. Employment

1. You acknowledge and agree that your employment with MODERN Staffing does not begin until you start your assignment through MODERN Staffing at a MODERN Staffing Client.

2. You acknowledge that this contract of employment is independent of any contract of employment under which you were currently employed by your current employer or were employed by your immediately preceding employer;

3. You acknowledge that your employment with MODERN Staffing does not constitute a transfer of employment from your current or former employer; and

4. You acknowledge that for the purposes of your employment with MODERN Staffing you do not consider MODERN Staffing to be a successor employer of your former employer.

5. Further, you hereby agree not to pursue or participate in any proceeding in which you will claim that MODERN Staffing is a successor employer who is obligated to you for rights you acquired under contracts of employment by which you were formerly employed.

6. Failure to show up for work on your scheduled shift without notice prior to the beginning of your shift may lead to termination for cause.

2. Employment Agreement and Assignment

1. You acknowledge and agree that once you accept an assignment through MODERN Staffing to a Client of MODERN Staffing your employment with MODERN Staffing will begin at which time an Employment Agreement will be mailed to you. This Employment Agreement will include the name of our agency, our contact information, as well as the name of the client you are being assigned to, their contact information, as well as your wage rate, hours of work, pay period, estimated term of the assignment, and a general description of the work. This information will be provided orally at the time it is initially provided and in writing as soon as practical thereafter. If you don’t receive this information within a reasonable time, please contact the MODERN Staffing administrator to request a copy of this information.

3. Employee Responsibilities

You acknowledge and agree that you are required to follow the below responsibilities. Failure to follow any of these may result in termination with cause.

1. As an employee of MODERN Staffing you cannot solicit work directly from any of our Clients, before, during or after your assignment. Solicitation for work directly from our Clients will result in termination for cause.
2. As an employee of MODERN Staffing you are required to complete WHMIS training prior to placement of an assignment and update your training annually.
3. As an employee of MODERN Staffing you are required to direct all questions or concerns to your supervisor at MODERN Staffing. You work for our agency, not MODERN Staffing’s Client that your assignment is taking place at.
4. All overtime MUST be approved by your supervisors both at MODERN Staffing and from your on-site supervisor. Overtime is paid after 44 hrs in one work week, at a rate of time and a half.
5. If you are going to be absent for any reason, you are to call the office phone number (between 8:00am and 5:00pm), or the after-hours phone number and leave your name, phone number, place of assignment and reason for not being able to report for work. A 24-hour notice is expected. Some emergencies are excusable. (See Time Off Policy)
6. You must follow the Client’s health and safety procedures. If you do not understand them, or do not feel that you have received adequate training in them it is your responsibility to contact your MODERN Staffing supervisor, who in turn will work with the Client to resolve the issue.
7. You are to report to work in a clean and neat appearance. Safety shoes and Safety glasses are to be worn at all times, unless otherwise instructed.
8. You should arrive at least 10 minutes before your shift starts to ensure you are ready to start work on time.
9. Breaks/Lunches are to be taken as instructed by your on-site supervisor.
10. While on assignment you are expected to work to the best of your ability. You are representing yourself as well as MODERN Staffing.
11. Use of cellular phones are not permitted during your work shift except during lunch or breaks.
12. You may not receive or give out any type of medication while on an assignment. This includes Tylenol, Advil etc.
13. No jewellery is allowed at all while on the job site. This is for your safety.
14. Smoking is permitted only in the designated areas as per the Client’s smoking policy.
15. No alcohol or drugs will be permitted or tolerated while on assignment with MODERN Staffing.
16. No swearing, violence or “horse play” will be tolerated.
17. Do not remove any materials from the facility where you are working at any time.

4. Confidentiality Agreement

1. You acknowledge and agree that all Client information provided by MODERN Staffing to you which is not publicly disclosed by MODERN Staffing or its Client shall be considered as confidential or proprietary to MODERN Staffing or its Client. You shall not, at any time during or after such assignment, disclose such information nor the nature of the service which you render to MODERN Staffing except to authorized representatives of MODERN Staffing or its Client.
2. You acknowledge and agree that all information (pertaining to MODERN Staffing or its Client's inventions, designs, tools, equipment, unpublished written materials, plans, processes, costs, methods, systems improvements, or other private or confidential matters) which is obtained by you in the performance of your work and which is not publicly disclosed by MODERN Staffing or its Client shall be considered as confidential or proprietary to MODERN Staffing or its Client. You shall not, at any time during or after such assignment, disclose such information nor the nature of the service which you render to MODERN Staffing except to authorized representatives of MODERN Staffing or its Client. The foregoing provision in this paragraph shall be for the benefit of MODERN Staffing or its Client.

5. Termination Clause

1. You acknowledge and agree that your employment may be terminated at any time, without cause, in which case MODERN Staffing shall provide you with written notice, or pay in lieu of notice and severance pay as per Appendix A and B if your assignment was originally estimated to last three months or longer and ends early.
2. You acknowledge and agree that MODERN Staffing will not have to give notice, or pay in lieu of notice, if offered another assignment that is reasonable and has an estimated term of at least equal to the Notice Period required under Appendix A.
3. You acknowledge and agree that if you have been found guilty if willful misconduct, disobedience or willful neglect of duty that is not trivial and has not been condoned by MODERN Staffing or the client; the assignment has become impossible to perform or has been frustrated by a fortuitous unforeseeable event or circumstance; to termination of Assignment the assignment is terminated during or as a result of a strike or lock-out you will not be entitled to notice or pay in lieu of.
4. In addition, you acknowledge and agree that you are not entitled to any notice and/or pay in lieu thereof, or severance pay as may be awarded through common law.
5. You acknowledge and agree that if you are assigned for a specific task or term, and you are terminated without cause before completion of the specified task or prior to the term date noted in the Employment Agreement presented to you upon assignment, MODERN Staffing shall only be required to provide you the minimum notice of termination and/or pay in lieu thereof, and severance pay (if applicable), as required pursuant to the Employment Standards Act, 2000 (as outlined in 5(a)).
6. You acknowledge and agree that if the employment agreement is not terminated upon completion of the assignment the employee must contact MODERN Staffing every Friday (or the day before if you are unable to do so on the Friday) through email, text message to the after-hours phone number, call the office or written notice (written notice can be received via fax, letter or in person) to confirm that you are available to work the following week. Failure to notify MODERN Staffing of your availability to work on any three straight weeks or four (4) of any six (6) weeks will result in termination for cause (deemed abandonment).
7. You acknowledge and agree that if the employment agreement is not terminated upon completion of the assignment and you refuse an assignment of similar work, with similar pay, you will be terminated for cause (deemed abandonment).
8. You acknowledge and agree that you will not solicit employment with a client of MODERN Staffing while you are employed by MODERN Staffing, whether or not you are currently assigned to provide services to that client. You further acknowledge and agree that you will not solicit employment with any clients of MODERN Staffing that you have been assigned to for a period of six months following the termination of your employment with MODERN Staffing, or completion of the assignment. Failure to adhere to these provisions will result in termination for cause.
9. You acknowledge and agree that MODERN Staffing employees are not allowed to be employees of competing agencies or companies. If you gain the employment of a competing agency or company you will be terminated for cause. You must notify MODERN Staffing immediately if alternative employment is found to indicate a lack of availability.
10. You acknowledge and agree that MODERN Staffing reserves the right to terminate your employment without notice should any representations you have made in regard to academic qualifications or work experience prove to be false.
11. You acknowledge and agree that if deemed termination occurs we will pay notice and severance as required. This amount will not exceed the amounts as calculated in Appendix A and B.

6. Cost to Confirm Qualifications

1. You acknowledge and agree that any expenses incurred by the agency in verifying your qualifications and/or fitness to work will be charged back to you. For greater certainty, you further acknowledge and agree that these are not “fees” pursuant to section 74.8 of the Employment Standards Act, 2000 (see Appendix C).

By signing the employment policy below, you indicate that you have read and understand the entire policy and how it applies to you.

Candidate Name (Legal First & Last Name) *

Candidate Agree Date *2025-05-03

This employment policy has been signed in the city of

*

in the province of Ontario.

Roles and Responsibilities of Workplace Parties

Employer Roles & Responsibilities

• Ensure that equipment, materials and protective devices as prescribed are provided
• Ensure that equipment, materials and protective devices provided are maintained in good condition
• Ensure that measures and procedures prescribed are carried out in the workplace
• Ensure that equipment, materials and protective devices provided by the employer are used as prescribed
• Provide information, instruction and supervision to a worker to protect the health or safety of the worker
• When appointing a supervisor, appoint a competent person
• Acquaint a worker or a person in authority over a worker with any hazard in the work and in the handling, storage, use, disposal and transport of any article, device, equipment or a biological, chemical or physical agent
• Afford assistance and co-operation to a committee and a health and safety representative in the carrying out by the committee and the health and safety representative of any of theft functions
• Only employ in or about a workplace a person over such age as may be prescribed
• Not knowingly permit a person who is under such age as may be prescribed to be in or about a workplace
• Take every precaution reasonable in the circumstances for the protection of a worker;
• Post, in the workplace, a copy of this Act and any explanatory material prepared by the Ministry, both in English and the majority language of the workplace, outlining the rights, responsibilities and duties of workers
• Prepare and review at least annually a written occupational health and safety policy and develop and maintain a program to implement that policy if over 5 employees
• Post at a conspicuous location in the workplace a copy of the occupational health and safety policy
• Provide to the committee or to a health and safety representative the results of a report respecting occupational health and safety that is in the employer’s possession and, if that report is in writing, a copy of the portions of that report that concern occupational health and safety; advise workers of the results of a report referred to in clause (1) and, if the report is in writing, make available to them on request copies of the portions of the report that concern occupational health and safety

Note: Where a designated substance or hazardous chemical or physical agent is present, consult the Ontario Health and Safety (OH&S) regulations for further responsibilities.

Supervisor Roles & Responsibilities

• Ensure that workers work in the manner and with the protective devices, measures and procedures required by the Ontario Health and Safety Act and the regulations
• Ensure that workers use or wear the equipment, protective devices or clothing that the employer requires to be used or worn
• Advise a worker of the existence of any potential or actual danger to the health or safety of the worker of which the supervisor is aware
• Where so prescribed, provide a worker with written instructions as to the measures and procedures to be taken for protection of the worker
• Take every precaution reasonable in the circumstances for the protection of a worker

Initial Required *

Worker Roles & Responsibilities

• Work in compliance with the provisions of the Health and Safety Act and the regulations
• Use or wear the equipment, protective devices or clothing that the worker’s employer or assigned Client requires to be used or worn
• Report to your employer and assigned Client supervisor the absence of or defect in any equipment or protective device of which the worker is aware and which may endanger himself or another worker
• Report to your employer and Client supervisor any contravention of the Health and Safety Act or the regulations or the existence of any hazard of which he knows
• Not remove or make ineffective any protective device required by the regulations or by your employer or assigned Client, without providing an adequate temporary protection device and when the need for removing or making ineffective the protective device has ceased, the protective device shall be replaced immediately
• Not use or operate any equipment, machine, device or thing or work in a manner that may endanger yourself or any other worker
• Not engage in any prank, contest, feat of strength, unnecessary running or rough and boisterous conduct
• You must follow the assigned client’s health and safety procedures. If you do not understand them, or do not feel that you have received adequate training in them it is your responsibility to contact your MODERN Staffing supervisor, who in turn will work with the Client to resolve the issue
• Be aware of your work station surroundings at all times
• Keep your work area clean

Note: Your signature below is acknowledgment that you are in agreement with the set responsibilities listed above, failure to comply may result in termination for cause.

Candidate Name *

Candidate Agree Date *2025-05-03

VIOLENCE IN THE WORK PLACE

The management of MEDA Limited / MODERN Staffing is committed to the prevention of workplace violence and is ultimately responsible for worker health and safety. We will take whatever steps reasonable to protect our workers from workplace violence from all sources: the exercise of physical force by a person against a worker, in a workplace, that causes or could cause physical injury to the worker; an attempt to exercise physical force against a worker, in a workplace, that could cause physical injury to the worker; or a statement or behaviour that it is reasonable for a worker to interpret as a threat to exercise physical force against the worker, in a workplace, that could cause physical injury to the worker. Notably, the definition of 'workplace violence' is not limited to acts, attempts or threats made by a worker against a worker (though the conduct must occur in the 'workplace').

Violent behaviour in the workplace is unacceptable from anyone. This policy applies to everyone that is employed by MEDA Limited / MODERN Staffing and anyone that MEDA Limited / MODERN Staffing does business with, for example: visitors, clients, delivery persons and volunteers. Everyone is expected to uphold this policy and to work together to prevent workplace violence. A workplace violence program that implements this policy. It includes measures and procedures to protect workers from workplace violence, a means of summoning immediate assistance and a process for workers to report incidents, or raise concerns. MEDA Limited / MODERN Staffing as the employer, will ensure this policy and the supporting program are implemented and maintained and that all workers and supervisors have the appropriate information and instruction to protect them from violence in the workplace. Supervisors will adhere to this policy and the supporting program. Supervisors are responsible for ensuring that measures and procedures are followed by workers and that workers have the information they need to protect themselves.

Every worker must work in compliance with this policy and the supporting program. All workers are encouraged to raise any concerns about workplace violence and to report any violent incidents or threats. All concerns need to be reported to a member of the Health and Safety team or any manager, there will be no negative consequences for reports made in good faith.

Management pledges to investigate and deal with all incidents and complaints of workplace violence in a fair and timely manner, respecting the privacy of all concerned as much as possible. A full investigation will be conducted and proper steps will be taken to ensure compliance with the Act. The workplace harassment policy will be consulted whenever there are concerns about harassment in the workplace.

Candidate Name *

Candidate Agree Date *2025-05-03

Appendix A – Notice Periods for Termination Pay

Notice Requirement

• When a regular work week does not exist; regular wages will equal the regular wages earned from the last 12 weeks worked before the termination date divided by 12.

Appendix B –Severance Periods

Severance Requirement

Initial Required *

Appendix C –Section 74.8 of the Employment Standards Act, 2000

Prohibitions

74.8 (1) A temporary help agency is prohibited from doing any of the following:

1. Charging a fee to an assignment employee in connection with him or her becoming an assignment employee of the agency.
2. Charging a fee to an assignment employee in connection with the agency assigning or attempting to assign him or her to perform work on a temporary basis for clients or potential clients of the agency.
3. Charging a fee to an assignment employee of the agency in connection with assisting or instructing him or her on preparing resumes or preparing for job interviews.
4. Restricting an assignment employee of the agency from entering into an employment relationship with a client.
5. Charging a fee to an assignment employee of the agency in connection with a client of the agency entering into an employment relationship with him or her.
6. Restricting a client from providing references in respect of an assignment employee of the agency.
7. Restricting a client from entering into an employment relationship with an assignment employee.
8. Charging a fee to a client in connection with the client entering into an employment relationship with an assignment employee, except as permitted by subsection (2).
9. Charging a fee that is prescribed as prohibited.

Initial Required *

General Safety Rules & Guidelines

• When entering our client site location (interviews/work) you MUST follow their policies & procedures.
• If there is onsite security ensure you follow their instructions and answer their questions; should you have a concern with client security please notify your MODERN representative.
• When starting a new position ensure you know the below as a basic guideline:
  • Who is your immediate onsite supervisor and who do you report concerns (hazards, defective equipment, incidents, injuries) to?
  • Any applicable safety protocols while working onsite?
  • Where the emergency exits are in the event of an emergency?
  • Where is the emergency meeting area in the event of an evacuation?
• What should be reported and address immediately while working onsite:
  • Any hazards as you identify them
  • Any defective equipment
  • Any incidents
    • Injuries
    • Near misses
    • Workplace Violence & Harassment
• Who should the issue be addressed to:
  • Your MODERN primary contact or MODERN HR representative
  • Client supervisor or client H&S representative (if you do not feel comfortable reporting to client personnel only report to MODERN contact)

Incident Reporting (Injury, Near Miss, Unsafe Work Environment, Violence, Harassment, any other issue while working onsite that are safety related):

• All incidents should be reported immediately.
• If you are injured while working at a client of MODERN you must notify MODERN right away. Remember MODERN is your employer. If you go to see a medical facility please advise the care giver that you are MODERN employee.
• Report to your assigned MODERN Account Manager.
• Should the accused be your MODERN Account Manager you must report the incident to the MODERN HR Manager.
• Should the accused be the Director of Operations of the MEDA Group discuss the incident with the President of the MEDA Group
• Should the accused be the President of the MEDA Group, discuss the incident with the HR Manager or another supervisor that does not directly report to the President.
• MODERN will conduct a proper investigation

Initial Required *

Candidate Agree Date *2025-05-03

HEALTH AND SAFETY POLICY

The management of MODERN Staffing is vitally interested in the health and safety of its workers. Protection of workers from injury or occupational disease is a major continuing objective.

MODERN Staffing will make every effort to provide a safe, healthy work environment. All supervisors and workers must be dedicated to the continuing objective of reducing risk and injury.

MODERN Staffing, as employer, is ultimately responsible for the health and safety of all employees. As Director of Operations, I give you my personal promise that every reasonable precaution will be taken for the protection of workers.

Supervisors will be held accountable for the health and safety of workers under their supervision.

Every worker must protect his or her own health and safety by working in compliance of the law and with safe work practices and procedures established and required by the employer.

It is in the best interest of all workplace parties to consider health and safety in every activity. A commitment to health and safety must form an integral part of this organization, from the managers to the workers.

Supervisors will educate, communicate and train on all aspects of violence in the workplace. Violence of any nature will not be tolerated in the workplace.

Candidate Name *

Candidate Agree Date *2025-05-03

AGREEMENT TO WORK EXCESS HOURS BETWEEN MODERN STAFFING &  _______

I agree to work excess hours (exceeding 8 hours in a day or 48 hours in a week) while employed with MODERN Staffing. I agree to inform MODERN Staffing if required to perform overtime. I understand that I may terminate this agreement at any time by informing MODERN Staffing. 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 MODERN Staffing.

This agreement expires at the end of your current employment contract.

Candidate Name *

Candidate Agree Date *2025-05-03

AGREEMENT TO WEEKLY VACATION PAYOUT BETWEEN MODERN STAFFING AND

Candidate Name *

I agree to have my vacation pay contribution included on my weekly pay. The total of 4% will be added for vacation pay. After five years of service the total added for vacation pay will be 6%.

I have read and understand that a valid written agreement needs to be completed in order to have vacation pay paid weekly.

I understand that I may terminate this agreement at any time by informing MODERN Staffing.

I understand that this agreement is entirely between myself and MODERN Staffing.

Candidate Name *

Candidate Agree Date *2025-05-03

Alternate Public Holiday Agreement

Public Holiday - Family Day

Some employers will substitute the statutory holiday (Family Day) for the Civic holiday.

I understand and agree that I will be paid holiday pay for the holiday of the employers’ choice.

Candidate Name *

Candidate Agree Date *2025-05-03

Please note: a copy of this completed agreement will be retained in your employee file.

Workplace Harassment Policy

MEDA/MODERN Staffing is committed to providing a work environment in which all workers are treated with respect and dignity. Workplace harassment will not be tolerated from any person in the workplace (including customers, clients, other employers, supervisors, workers and members of the public, as applicable).

Workplace harassment means engaging in a course of vexatious comment or conduct against a worker in a workplace that is known or ought reasonably to be known to be unwelcome or workplace sexual harassment.

Workplace sexual harassment means:

1. engaging in a course of vexatious comment or conduct against a worker in a workplace because of sex, sexual orientation, gender identity or gender expression, where the course of comment or conduct is known or ought reasonably to be known to be unwelcome, or
2. making a sexual solicitation or advance where the person making the solicitation or advance is in a position to confer, grant or deny a benefit or advancement to the worker and the person knows or ought reasonably to know that the solicitation or advance is unwelcome.

Reasonable action taken by the employer or supervisor relating to the management and direction of workers or the workplace is not workplace harassment.

Workers are encouraged to report any incidents of workplace harassment to the appropriate person. Any incident(s) of workplace harassment should be reported immediately to the Human Resources Manager.

Management will investigate and deal with all complaints or incidents of workplace harassment in a fair, respectful and timely manner. Information provided about an incident or about a complaint will not be disclosed except as necessary to protect workers, to investigate the complaint or incident, to take corrective action or as otherwise required by law.

Managers, supervisors and workers are expected to adhere to this policy, and will be held responsible by the employer for not following it. Workers are not to be penalized or disciplined for reporting an incident or for participating in an investigation involving workplace harassment.

If a worker needs further assistance, he or she may contact a member of the Joint Health & Safety Committee, Human Rights Legal Support Centre or employee assistance program.

Candidate Name *

Candidate Agree Date *2025-05-03

TIME OFF POLICY

Intent

MODERN Staffing understands the importance of personal time off for its employees. As such, the purpose of this policy is to explain the standards, guidelines, and procedures for time off for all staff members.

Vacation Guidelines

All employees are expected to use their allotted vacation time in full every year. The following policy statements are intended to clarify vacation procedures for MODERN Staffing staff.

Vacations must be taken sometime in the 12 months after the employee becomes entitled to the vacation. Vacations will normally be authorized in one-week periods unless the employee requests to take their vacations in shorter periods.

Vacation pay contributions are included in MODERN Staffing‘s weekly payroll.

• Employees with one (1) or more years of service will be granted vacation according to the following schedule:

• Employees shall receive vacation pay at the rate of four (4) percent of their earnings for service of one year, but less than five (5) years and six (6) percent after five (5) years of service.
  
  
• If a statutory holiday or a company recognized holiday occurs during an employee’s vacation period, the employee is entitled to in agreement with the employer, another day before the next annual vacation period.

Unpaid Time Off Guidelines

• Occasionally employees book unpaid time off, which are separate from vacation.

• These requests are evaluated on case by case bases which are determined by staff availability and workload.

• Employees who have been found to be exploiting this system by booking excessive and frequent unpaid time off may face progressive disciplinary action.

Sick Leave: MODERN Staffing provides up to 3 unpaid Sick Leave days per calendar year where employee has been employed for 2 consecutive weeks. Leave is for employee’s own personal illness, injury or medical emergency. MODERN Staffing may require evidence to ensure the employee is eligible for sick leave. An absence for a partial day will result in the use of a full Sick Leave day.

Family Responsibility Leave: MODERN Staffing provides up to 3 unpaid family responsibility leave days each calendar year for family responsibility leave where employee has been employed for 2 consecutive weeks. To be used for illness, injury or medical emergency of a listed family member, or for an urgent matter that affects a listed family member. An absence for a partial day will result in the use of a full Family Responsibility Leave day.

Bereavement Leave: MODERN Staffing provides up to 2 unpaid Bereavement Leave days each calendar year for bereavement leave where employee has been employed for 2 consecutive weeks. To be used for the death of a listed family member. An absence for a partial day will result in the use of a full Bereavement Leave day.

• Listed Family Members are defined as:

• spouse (includes both married and unmarried couples, of the same or opposite genders)
• parent, step-parent, foster parent, child, step-child, foster child, grandparent, step-grandparent, grandchild or step-grandchild of the employee or the employee's spouse
• spouse of the employee's child
• brother or sister of the employee
• relative of the employee who is dependent on the employee for care or assistance

• You may not carry over Sick, Family Responsibility or Bereavement Leave days into the next calendar year.

• The expectation under Sick, Family Responsibility or Bereavement Leave Days policies is that staff will cooperate with the established MODERN Staffing attendance guidelines, including notification and reporting procedures.

• Sick, Family Responsibility or Bereavement Leave Days will not be allotted during any type of leave of absence.

• Abuse of Sick, Family Responsibility or Bereavement Leave Days for the sole purpose to lengthen vacation or holiday periods is prohibited.

• Supervisors and managers have been instructed to remain vigilant of the suspicious patterns particularly if the patterns are chronic and persistent:

• Sick, Family Responsibility or Bereavement Leave Days taken on weekends, Saturdays, or Sundays where the employee is scheduled to work.
• Sick, Family Responsibility or Bereavement Leave Days during the day before and/or the day after scheduled vacation day(s) or statutory holiday(s).
• Sick, Family Responsibility or Bereavement Leave Days during the day immediately following a pay day.
• Situations where the absence(s) coincides with desirable days off.

• Employees who have been found in abuse of Sick, Family Responsibility or Bereavement Leave Days policy will face disciplinary action.

• MODERN Staffing reserves the right, at their sole discretion, to request evidence that employees are eligible for Sick, Family Responsibility or Bereavement Leave. Evidence of absences not covered by the above Leaves may be required before employee is allowed to return to work.

Legislative Leaves

In addition to the time off outlined in this policy, if required stipulations are met MODERN Staffing will also grant all legislatively required leaves. Taking a legislative leave will not negatively affect your employment with MODERN Staffing and will not be counted as time off’.

Acknowledgement & Agreement

I acknowledge that I have read and understand the Time Off Policy of MODERN Staffing. 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.

Candidate Name *

Candidate Agree Date *2025-05-03

Marijuana Policy

Medical Marijuana in the Workplace

MODERN Staffing will provide reasonable accommodation to an employee who is prescribed marijuana for medical reasons where appropriate medical evidence is provided. Medical evidence must include sufficient medical indication that the employee actually has to ingest marijuana during working hours, together with sufficiently detailed information regarding the frequency, volume and method of ingestion relating to such prescribed medical use. Employees prescribed marijuana for medical reasons and who need to ingest marijuana during working hours for medical reasons have a duty to disclose any use of marijuana in the workplace.

MODERN Staffing’s duty to accommodate does not include:

• Allowing an employee to work in an impaired state;
• Allowing an employee to work where safety will be compromised; or
• Allowing an employee to smoke marijuana at work.

Recreational Marijuana in the Workplace

Employees are strictly prohibited from smoking, vaping, using electronic cigarettes, consuming edible marijuana, or consuming marijuana by any other means for recreational purposes during working hours and/or coming to work intoxicated. Employees are also strictly prohibited from possessing marijuana in any form in the workplace. Employees whose behaviour raises safety concerns who attend work in an intoxicated state are subject to disciplinary action up to and including termination of employment.

I have read and understand the above MODERN Staffing Marijuana Policy.

Candidate Name *

Candidate Agree Date *2025-05-03

For additional information on marijuana in the workplace please visit: https://www.labour.gov.on.ca/english/hs/pubs/impairment.php

DISCONNECTING FROM WORK POLICY

June 1, 2022

Modern Staffing Disconnecting from Work Policy – Modern Staffing Field Employees

The health and well-being of our employees is of the utmost importance to Modern Staffing (Modern). Disconnecting from work is vital for a person’s welfare, physical and mental wellbeing, and is part of Modern’s commitment to providing a work-life balance for all its employees.

Policy:

Modern’s Disconnect from Work policy covers employees working traditional hours in the workplace and those working remotely or have flexible (hybrid) working arrangements. Every employee has the right to, and should, disconnect from work outside of their normal working hours. Modern understands that there may be, on occasions situations when it is necessary to conduct business outside of normal working hours as such the rise of an emergency or unforeseeable circumstance.

In addition to Modern’s Disconnecting from Work policy employees assigned to clients of Modern must follow that client’s Disconnecting from Work policy. Modern will communicate the client Disconnecting from Work policy to its field employee(s) as required. A client specific Disconnecting from Work policy will be distributed by Modern to the field employee(s) within a reasonable time of Modern learning about the client policy.

This policy does not prohibit a Modern employee, nor a client of Modern’s from sending an email to a co-worker outside of normal business hours; it addresses the expectation of prompt responses to these emails. Modern employees assigned to a client are not required to review their work-related emails outside of normal business hours unless previously discussed with their Modern representative or a member of the client’s Management regarding a special circumstance.

Definitions

A. Employment Standards Act defines the right to disconnect from work as, “not engaging in work-related communications, including emails, telephone calls, video calls or sending or reviewing other messages, to be free from the performance of work.”

Acknowledgement & Agreement

I, the undersigned, hereby acknowledge that I have read and understand the Disconnect from Work Policy of Modern. I agree to adhere to this policy and will ensure that employees working under my direction adhere to this Policy.

I (Candidate Name) agree Yes to the above *

Candidate Agree Date *2025-05-03

MODERN STAFFING HYGIENE POLICY

Please review the personal hygiene policy as a reminder that MODERN Staffing employees are expected to meet hygiene requirements during business hours for the duration of their employment.

• Use of deodorant / anti-perspirant to minimize body odours is a requirement at all times
• Maintain personal cleanliness by bathing regularly
• Oral hygiene (brushing of teeth) required
• No scented perfumes, colognes and lotions
• Wash hands with soap after eating and after using restrooms
• Secure long hair (hair must be tied back to prevent potential for being caught in equipment)
• Clothing must be clean

Thank you for your cooperation.

I (Candidate Name) agree Yes to the above *

Candidate Agree Date *2025-05-03

MODERN STAFFING - ABSENTEE LINE

I (Candidate Name) agree Yes to the above *

Candidate Agree Date *2025-05-03

WHMIS Testing

I have completed this quiz without the help of others.

Candidate Name (Legal First & Last Name) *

Candidate Agree Date *2025-05-03

Step 1 Get On Board Quiz

Step 2 Get in the Know Quiz

Step 3 Get Involved Quiz

Step 4 Get More Help Quiz

Fair At Work Ontario

Employment Standards in Ontario

The Employment Standards Act, 2000 ( ESA ) protects employees and sets minimum standards for most workplaces in Ontario.

Employers are prohibited from penalizing employees in any way for exercising their ESA rights.

What you need to know

Minimum wage

Most employees are entitled to be paid at least the minimum wage. For current rates visit: Ontario.ca/minimumwage

Hours of work and overtime

There are daily and weekly limits on hours of work, and rules around meal breaks, rest periods and overtime. For more information visit: Ontario.ca/hoursofwork and Ontario.ca/overtime.

Public holidays

Ontario has a number of public holidays each year. Most employees are entitled to take these days off work and be paid public holiday pay. For more information visit:Ontario.ca/publicholidays.

Vacation time and pay

Most employees earn vacation time after every 12 months of work. There are rules around the amount of vacation pay an employee earns. For more information visit: Ontario.ca/vacation.

Leaves of absence

There are a number of job-protected leaves of absence in Ontario. Examples include pregnancy, parental and family caregiver leave. For more information visit: Ontario.ca/ESAguide.

Termination notice and pay

In most cases, employers must give advance written notice when terminating employment and/or termination pay instead of notice. For more information visit: Ontario.ca/terminationofemployment.

Other employment rights, exemptions and special rules

There are other rights, exemptions and special rules not listed on this poster including rights to severance pay and special rules for assignment employees of temporary help agencies.

Subscribe to stay up-to-date on the latest news that can affect you and your workplace: Ontario.ca/labournews

Learn more about your rights at: Ontario.ca/employmentstandards

1-800-531-5551 or TTY 1-866-567-8893

Twitter: https://twitter.com/@ONlabour
Facebook: https://facebook.com/OntarioMinistryofLabour

Name *

Date *2025-05-03

Employment Standards in Ontario

The Employment Standards Act, 2000 (ESA) protects employees and sets minimum standards for most workplaces in Ontario.
Employers are prohibited from penalizing employees in any way for exercising their ESA rights.

What you need to know

Minimum wage
Most employees are entitled to be paid at least the minimum wage. For current rates visit: Ontario.ca/minimumwage
Hours of work and overtime
There are daily and weekly limits on hours of work, and rules around meal breaks, rest periods and overtime. Ontario.ca/hoursofwork | Ontario.ca/overtime
Public holidays
Ontario has a number of public holidays each year. Most employees are entitled to take these days off work and be paid public holiday pay. Ontario.ca/publicholidays
Vacation time and pay
Most employees earn vacation time after every 12 months of work. There are rules around the amount of vacation pay an employee earns. Ontario.ca/vacation
Termination notice and pay
In most cases, employers must give advance written notice when terminating employment and/or termination pay instead of notice. Learn more at Ontario.ca/terminationofemployment
Leaves of absence
There are a number of job-protected leaves of absence in Ontario. Examples include pregnancy, parental, family caregiver, personal emergency leave (paid and unpaid) and sexual and/or domestic violence leave (paid and unpaid).
Other employment rights, exemptions and special rules
There are other rights, exemptions and special rules not listed on this poster including rights to severance pay and special rules for assignment employees of temporary help agencies. Ontario.ca/labournews

Subscribe to stay up-to-date on the latest news that can affect you and your workplace: Ontario.ca/labournews
Learn more about your rights at:   http://www.ontario.ca/employmentstandards
1-800-531-5551 or TTY 1-866-567-8893

Your Employment Standards Rights – Temporary Help Agency Assignment Employees

This information sheet gives a summary of the Employment Standards Act, 2000 ( ESA)  rights for assignment employees of temporary help agencies. The ESA is a law that sets minimum standards in most Ontario workplaces, such as the minimum wage, limits on hours of work, overtime pay, vacations, and job-protected leaves from work for certain reasons. Special rules and exemptions may apply depending on what kind of work you do. For more information visit Ontario.ca/ESAguide.

Assignment employees of a temporary help agency

You are an assignment employee of a temporary help agency if you and the agency have agreed that it will place or try to place you on temporary work assignments with a client business (or client businesses) of the agency. You have an employment relationship with the agency even when you are not on an assignment with a client business of the agency.

Right to public holidays and public holiday pay

Ontario has nine public holidays. Generally, if you are on an assignment and the public holiday falls on a day when you would ordinarily be working, you have a right to take the public holiday off work and to be paid public holiday pay for that day. Public holiday pay is generally your gross regular wages earned plus vacation pay payable in the four work weeks before the work week that  Ministry of Labour 2 includes the public holiday, divided by 20. A different calculation applies for public holidays between January 1, 2018 and June 30, 2018.

If you agree in writing, including electronically, to work on the holiday, you then have the right to public holiday pay plus premium pay (at least one and one-half times your regular rate of pay), or your regular rate of pay plus a substitute day off with public holiday pay.

For further information on public holidays, please see the “Temporary Help Agencies” chapter in Your Guide to the Employment Standards Act, available at Ontario.ca/ESAguide.

Right to notice of termination and severance pay

If you have been employed by a temporary help agency for at least three months, you generally have a right to receive notice of termination if the agency ends (terminates) your employment relationship. You may get notice while you are working, pay instead of working notice, or a combination of both. Generally, the minimum notice you must get ranges from one week (if you have been employed for at least three months but less than one year) to eight weeks (if you have been employed for eight years or more). Your notice entitlement is determined by how long you are employed by the agency, not the length of time you have been working on assignments at the agency’s client business(es).

Different rules apply to a mass termination when 50 or more assignment employees are terminated within the same four-week period.

If you have been an employee of an agency for five or more years, you may also have a right to severance pay if the agency ends (severs) your employment.

For further information on notice of termination, mass termination and severance pay, please see the “Temporary Help Agencies” chapter in Your Guide to the Employment Standards Act, available at  Ontario.ca/ESAguide.

Right to notice of termination of assignment 

Termination of assignment – which differs from termination of employment – occurs when an assignment employee has his/her assignment with a client terminated, yet remains employed with the temporary help agency.

Generally, a temporary help agency is required to provide an assignment employee with either one week’s written notice of termination of assignment, termination of assignment payor a combination of both if:

1.  the assignment employee is assigned to perform work for a client;

2.  the assignment had an estimated term of three months or more at the time it was offered to the employee; and

3.  the assignment is terminated before the end of its term.

For further information on termination of assignment, please see the “Temporary Help Agencies” chapter in Your Guide to the Employment Standards Act , available at Ontario.ca/ESAguide.

An agency cannot charge you certain fees

An agency cannot charge you a fee for being its employee or for helping you find an assignment. It cannot charge you a fee for giving you information or advice on how to write a resume or prepare for an interview, even when the information or advice was provided at your request.

If a client business of an agency wants to give you a job reference or hire you to be its employee

An agency cannot prevent a client business from giving you a job reference.

An agency cannot prevent its client business from hiring you directly if the client business wants to do so. If the agency places you on an assignment with a client business, it can charge the client business a fee for hiring you, but only in the six-month period beginning on the day you first started working for the client business.

If a client business of an agency wants to hire you to be its employee, an agency cannot tell you that you cannot take the job. An agency cannot charge you a fee if a client business wants to hire you.

Information must be provided about the agency

The agency must give you the agency’s legal name and contact information. This information must be provided, in writing, as soon as possible after you become an assignment employee.

Information must be provided about assignments

When the agency offers you an assignment with one of its client businesses, it must give you the client business’ legal name and contact information; the wage rate and benefits (if any); the hours of work; a general description of the work; the estimated term of the assignment (if known); and the pay period and pay day. If the agency gives you this information, but does not provide it in writing when the offer is made, the agency must provide it in writing as soon as possible.

Information must be provided about the ESA

The agency is required to provide you with a copy of this information sheet as soon as possible after you become an assignment employee. 

If your first language is not English, the agency must find out if the information sheet is available in your first language, and if so, the agency must supply both the English version and the translated document to you. Multilingual resources are available at Ontario.ca/employmentrights.

The agency must also provide you with a copy of the Employment Standards Poster published by the Ministry of Labour within 30 days of the date you become an employee. 

If you request a copy of the poster in a language other than English and the ministry has published a version in that language, the agency must provide the translated version in addition to the English copy. The poster is available at Ontario.ca/ESAposter.

You cannot be punished for asking about or exercising your ESA rights

If you ask about your rights under the ESA or ask that you be given your rights, the agency or the client business cannot punish you in any way, including by ending your assignment. You also have the right not to be punished by your agency or by the client for asking about or exercising your ESA rights.

The agency and client business must keep records

An agency must record the number of hours an assignment employee worked for each client in each day and each week. The client(s) must also record the number of hours the assignment employee worked for them in each day and each week.

The agency and client may both be liable for your wages

If you perform work for a client business or client businesses and the agency fails to pay you some or all of the wages owed for that pay period, the client business(es) may be jointly and severally liable for some or all of those unpaid wages. Specifically, client businesses may be held liable for unpaid regular wages, overtime pay, public holiday pay and public holiday premium pay. If more than one client business is liable in a pay period, each client business is jointly and severally liable with the agency for a share of the total wages owed in proportion to the hours worked for that client business.

If you have a question or want to file a claim

If you have questions about the ESA call the Ministry of Labour’s Employment Standards Information Centre at 416-326-7160, toll free at 1-800-531-5551, or TTY 1-866-567-8893. Information is available in multiple languages.

To file a claim, you can access the Employment Standards Claim Form online at Ontario.ca/ESAforms.

Name *

Date *2025-05-03

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