Email Address*

Password
length must be between 8 to 15 characters.

Must have one upper case character, one lower case character, one numeric and one special character.

Allowed Special characters:
@, #, $, %, ^, &, +, =, !
 

Confirm Password

First Name

Last Name

Title

Position

Are you a worker or manager?

Are you a JHSC member or worker rep?

Organization Name

Primary Address

Apartment Number

Street Number*

Street Name*

Post Office Box

City*

Province

Postal Code*

Phone

Work Phone

Work Extension

Fax

Alternate Address

Address

City

Province

Postal Code

Alternate Phone

Preferred Contact Method

How many persons are employed at your worksite?

Is your company/organization unionized?

If yes, which Union?*

Union Local

Work Environment