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For agencies with 1-75 employees
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Agency Name:
Street:
Unit number:
City:
Province:
Postal Code:
Agency contact:
Contact e-mail:
Contact phone #:
Fax:
Is your agency currently a member of the following associations?

Capacity Builders
In Kind Canada
OACAO
OCSA
Volunteer Alberta
None
How did you find out about OASSIS?
Does your agency currently have a benefits plan?
Yes
No
Integrated or non-integrated Short term disability?
Taxable or non taxable Long term disability?
Basic Life 1x or 2x annual salary
1x
2x
Do you want a Drug Card?
Health & Dental plan (our plans)
Disability module
EAP (employee assistance program)
Employee position
Annual Income
Single or Family or
Waive Health & Dental?
Part-time/ Full-time Status?
Dependant Life
1
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