ctcvaxform.com
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Submitted URL: http://ctcvaxform.com/
Effective URL: https://ctcvaxform.com/
Submission: On October 15 via manual from CA — Scanned from DE
Effective URL: https://ctcvaxform.com/
Submission: On October 15 via manual from CA — Scanned from DE
Form analysis 1 forms found in the DOM
<form id="loginForm" class="loginForm">
<div class="row">
<div class="col col-12">
<div class="container px-0 singleNameOptionContainer my-4 container--fluid">
<div class="v-input mx-4 theme--light v-input--selection-controls v-input--checkbox">
<div class="v-input__control">
<div class="v-input__slot">
<div class="v-input--selection-controls__input"><i aria-hidden="true" class="v-icon notranslate material-icons theme--light">check_box_outline_blank</i><input aria-checked="false" id="singleName" role="checkbox" type="checkbox"
value="">
<div class="v-input--selection-controls__ripple"></div>
</div><label for="singleName" class="v-label theme--light" style="left: 0px; right: auto; position: relative;">Check this box only if you have a Single Name on your Registered Birth Certificate or Change of Name Certificate (rather than
a First Name and Last Name).</label>
</div>
<div class="v-messages theme--light">
<div class="v-messages__wrapper"></div>
</div>
</div>
</div>
</div>
<div class="field loginField"><label for="firstname">First Name: </label> <!---->
<div class="v-input theme--light v-text-field v-text-field--single-line v-text-field--solo v-text-field--is-booted v-text-field--enclosed">
<div class="v-input__control">
<div class="v-input__slot">
<div class="v-text-field__slot"><input id="firstname" type="text"></div>
</div>
<div class="v-text-field__details">
<div class="v-messages theme--light">
<div class="v-messages__wrapper"></div>
</div>
</div>
</div>
</div>
</div>
<div class="field loginField"><label for="lastname">Last Name: </label>
<div class="v-input theme--light v-text-field v-text-field--single-line v-text-field--solo v-text-field--is-booted v-text-field--enclosed">
<div class="v-input__control">
<div class="v-input__slot">
<div class="v-text-field__slot"><input id="lastname" type="text"></div>
</div>
<div class="v-text-field__details">
<div class="v-messages theme--light">
<div class="v-messages__wrapper"></div>
</div>
</div>
</div>
</div>
</div>
<div class="field loginField"><label for="employeeNumber">Employee Number: </label>
<div class="v-input theme--light v-text-field v-text-field--single-line v-text-field--solo v-text-field--is-booted v-text-field--enclosed">
<div class="v-input__control">
<div class="v-input__slot">
<div class="v-text-field__slot"><input id="employeeNumber" type="text"></div>
</div>
<div class="v-text-field__details">
<div class="v-messages theme--light">
<div class="v-messages__wrapper"></div>
</div>
</div>
</div>
</div>
</div>
<div class="field loginField"><label for="division">Business Unit - Location: </label>
<div class="v-input theme--light v-text-field v-text-field--is-booted v-select">
<div class="v-input__control">
<div role="button" aria-haspopup="listbox" aria-expanded="false" aria-owns="list-22" class="v-input__slot">
<div class="v-select__slot">
<div class="v-select__selections"><input id="input-22" readonly="readonly" type="text" aria-readonly="false" autocomplete="off"></div>
<div class="v-input__append-inner">
<div class="v-input__icon v-input__icon--append"><i aria-hidden="true" class="v-icon notranslate material-icons theme--light">arrow_drop_down</i></div>
</div><input type="hidden">
</div>
<div class="v-menu"><!----></div>
</div>
<div class="v-text-field__details">
<div class="v-messages theme--light">
<div class="v-messages__wrapper"></div>
</div>
</div>
</div>
</div>
</div>
<div class="field loginField"><label for="managerFirstName">Supervisor First Name: </label>
<div class="v-input theme--light v-text-field v-text-field--single-line v-text-field--solo v-text-field--is-booted v-text-field--enclosed">
<div class="v-input__control">
<div class="v-input__slot">
<div class="v-text-field__slot"><input id="managerFirstName" type="text"></div>
</div>
<div class="v-text-field__details">
<div class="v-messages theme--light">
<div class="v-messages__wrapper"></div>
</div>
</div>
</div>
</div>
</div>
<div class="field loginField"><label for="managerLastName">Supervisor Last Name: </label>
<div class="v-input theme--light v-text-field v-text-field--single-line v-text-field--solo v-text-field--is-booted v-text-field--enclosed">
<div class="v-input__control">
<div class="v-input__slot">
<div class="v-text-field__slot"><input id="managerLastName" type="text"></div>
</div>
<div class="v-text-field__details">
<div class="v-messages theme--light">
<div class="v-messages__wrapper"></div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="formsectionheader col col-12">
<h2>Vaccination Status</h2>
</div>
</div>
<div class="row">
<div class="col col-12">
<div class="container vaccineOptionContainer container--fluid">
<div class="v-input theme--light v-input--selection-controls v-input--radio-group v-input--radio-group--column">
<div class="v-input__control">
<div class="v-input__slot" style="height: auto;">
<div role="radiogroup" aria-labelledby="input-33" class="v-input--radio-group__input">
<legend id="input-33" class="v-label theme--light" style="left: 0px; right: auto; position: relative;">
<div class="text-15em">Which option applies to you?</div>
</legend>
<div class="v-radio theme--light">
<div class="v-input--selection-controls__input"><i aria-hidden="true" class="v-icon notranslate material-icons theme--light">radio_button_unchecked</i><input aria-checked="false" id="input-34" role="radio" type="radio"
name="radio-33" value="full">
<div class="v-input--selection-controls__ripple"></div>
</div><label for="input-34" class="v-label theme--light" style="left: 0px; right: auto; position: relative;">
<div class="vaccineOption">I have been fully vaccinated against Covid-19 and it has been at least 14 days since I received the last dose (i.e. both doses of a 2 dose vaccine or 1 dose of a single dose vaccine)</div>
</label>
</div>
<div class="v-radio theme--light">
<div class="v-input--selection-controls__input"><i aria-hidden="true" class="v-icon notranslate material-icons theme--light">radio_button_unchecked</i><input aria-checked="false" id="input-36" role="radio" type="radio"
name="radio-33" value="unvaccinated">
<div class="v-input--selection-controls__ripple"></div>
</div><label for="input-36" class="v-label theme--light" style="left: 0px; right: auto; position: relative;">
<div class="vaccineOption">I am not currently vaccinated against Covid-19</div>
</label>
</div>
<div class="v-radio theme--light">
<div class="v-input--selection-controls__input"><i aria-hidden="true" class="v-icon notranslate material-icons theme--light">radio_button_unchecked</i><input aria-checked="false" id="input-38" role="radio" type="radio"
name="radio-33" value="undisclosed">
<div class="v-input--selection-controls__ripple"></div>
</div><label for="input-38" class="v-label theme--light" style="left: 0px; right: auto; position: relative;">
<div class="vaccineOption">I am not disclosing my Covid-19 vaccination status</div>
</label>
</div>
</div>
</div>
<div class="v-messages theme--light">
<div class="v-messages__wrapper"></div>
</div>
</div>
</div>
</div>
</div>
</div> <!---->
<div class="row">
<div class="col col-12">
<div class="container px-0 singleNameOptionContainer my-4 container--fluid">
<div class="v-input mx-4 theme--light v-input--selection-controls v-input--checkbox">
<div class="v-input__control">
<div class="v-input__slot">
<div class="v-input--selection-controls__input"><i aria-hidden="true" class="v-icon notranslate material-icons theme--light">check_box_outline_blank</i><input aria-checked="false" id="consent" role="checkbox" type="checkbox" value="">
<div class="v-input--selection-controls__ripple"></div>
</div><label for="consent" class="v-label theme--light" style="left: 0px; right: auto; position: relative;">
<div>
<p>I understand I am required to provide accurate and true information on this form and that any failure to do so may result in disciplinary action, up to and including the termination of my employment. I further understand that if
I do not follow required safety protocols that the Corporation has put in place, this may also result in disciplinary action, up to and including termination of my employment. By clicking this box, I affirm that I accurately and
truthfully answered all of the questions asked on this form.</p>
</div>
</label>
</div>
<div class="v-messages theme--light">
<div class="v-messages__wrapper"></div>
</div>
</div>
</div>
</div>
<div class="text-1em"> NOTE: This consent only applies to this specific form. If you did not upload proof of vaccination, then checking this box does not constitute consent to obtain the information through other means. </div>
</div>
</div>
<div class="row">
<div class="col col-12" style="text-align: center;"><button type="button" disabled="disabled" class="filterButton mx-5 mb-2 v-btn v-btn--disabled v-btn--has-bg theme--light v-size--x-large" primary="" raised="" style="color: white;"><span
class="v-btn__content"> Submit </span></button></div>
</div>
<div class="row">
<div class="pb-8 col col-12" style="text-align: center;"> Please email the <a href="mailto:ctcvaxformssupport@cantire.com">ctcvaxformssupport@cantire.com</a> for technical support. </div>
</div>
</form>Text Content
Vaccination Disclosure Form FR Close Close Canadian Tire Corporation, Limited (the “Corporation”) continues to strive to help ensure a workplace free from recognized hazards, and to promote the health and well-being of those on our campus locations. As part of this effort, we have implemented safety protocols in accordance with applicable law and public health recommendations and continue to look for ways to promote safety and minimize the risk of transmission of COVID-19 in the workplace. To assist with these initiatives, in order to be granted access to one of the Corporation’s campus locations it is mandatory that employees be fully vaccinated against COVID-19 or partake in regular testing unless accommodation is requested under applicable human rights legislation. All fields are required unless specified as (optional). INFORMATION check_box_outline_blank Check this box only if you have a Single Name on your Registered Birth Certificate or Change of Name Certificate (rather than a First Name and Last Name). First Name: Last Name: Employee Number: Business Unit - Location: arrow_drop_down Supervisor First Name: Supervisor Last Name: VACCINATION STATUS Which option applies to you? radio_button_unchecked I have been fully vaccinated against Covid-19 and it has been at least 14 days since I received the last dose (i.e. both doses of a 2 dose vaccine or 1 dose of a single dose vaccine) radio_button_unchecked I am not currently vaccinated against Covid-19 radio_button_unchecked I am not disclosing my Covid-19 vaccination status check_box_outline_blank I understand I am required to provide accurate and true information on this form and that any failure to do so may result in disciplinary action, up to and including the termination of my employment. I further understand that if I do not follow required safety protocols that the Corporation has put in place, this may also result in disciplinary action, up to and including termination of my employment. By clicking this box, I affirm that I accurately and truthfully answered all of the questions asked on this form. NOTE: This consent only applies to this specific form. If you did not upload proof of vaccination, then checking this box does not constitute consent to obtain the information through other means. Submit Please email the ctcvaxformssupport@cantire.com for technical support.