English

This form is for employers to refer their employees for assistance. Emergency relief assistance may be available to workers who have lost employment due to employer's loss of their home or business because of the January 2025 wildfires. (Please fill out a separate form for each employee).

Employer Information

Clear choice

If your home was impacted by the fires you have insurance information that you can share, please do so below.

Your Insurance Claim Information

 

OR

Delete all uploads
Choose files or drag here

Impacted Employee Information:

 

How much did you pay them (per hour & per month)? What type of work did this employee do? How long did they work for you?

Please select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20