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Employee ID Tag Request Form

"*" indicates required fields

EMPLOYEE INFOMATION

Legal Name*
(as it appears on your SIN card)

SHIPPING CONTACT & ADDRESS INFORMATION

(please complete in full to avoid delivery delays & returned mail)
IERHA Site Address

TAG INFORMATION

Tag request for:*
Badge type:*
  • Lanyard or Clips are provided for NEW & LOST IDs, or if they are damaged
  • A non-refundable $20 fee. processed via payroll deduction for replacing LOST IDs
  • Damaged IDs must be returned to ID Badge Requests at: Corporate Office (please include this form)
  • Old IDs must be returned to Badge Requests at: Corporate Office (please include this form)
How would you like your name to appear on you ID
ID Bagde Image
DO NOT use abbreviations for Position

Accepted file types: jpeg, jpg, png, bmp, gif, Max. file size: 10 MB.
This field is for validation purposes and should be left unchanged.
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