Registration Form

Small Employer Certificate of Recognition (SECOR)

1. Program Information:

Yes, I have read the program summary and I would like to participate in the Saskatchewan Construction Safety Association (SCSA) Small Employer Certificate of Recognition program.

2. Company Information:

Legal Name (*)

Operating Name (*)

SK WCB Account # [Ex. 7382910 or A394829] (*)

SK WCB Rate Code(s) [Ex. B1101] (*)

City (*)

Postal Code (*)

Address (*)

Phone (*)

Fax

Email (*)

I consent to receiving electronic communications from the SCSA

Owner (*)

Do you have any related companies? (*)

Yes
No

If yes, please list below (* = required).

Legal Name (*)

SK WCB Account # [Ex. 7382910 or A394829] (*)

SK WCB Rate Code(s) [Ex. B1101] (*)

Legal Name

SK WCB Account # [Ex. 7382910 or A394829]

SK WCB Rate Code(s) [Ex. B1101]

Do you, or will your company act in the role of a general contractor, or management company employing more than 9 workers on a regular basis? (*)

Yes
No

If yes, please provide an explanation where you may employ more than nine workers (required).