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Following submission of the form I would like to be contacted by:  E-mail Phone

Preferred Language of Service:  English French

Details

Last Name:*

First Name:*

Middle Name/Nickname:

I identify as (select only one):*  Male Female Trans Prefer not to disclose Other

Date of Birth:*

Marital Status:*  Single Married (or equivalent) Undisclosed
Status in Canada:*  Canadian Citizen Permanent Resident Other

Date Arrived in Canada:

Please complete if you wish to self-identify as a member of a designated group(s). Your response to this question is entirely voluntary and will not affect your eligibility. This information will be used by the Governments of Ontario and Canada for policy analysis and statistical purposes related to employment programs and services.

 Newcomer Visible Minority Métis Person With Disability First Nations Inuit

Address

Primary Mailing Address

Unit/Apt: Street Number and Name:*
City:* Province: Ontario
Postal Code:*

Alternate Mailing Address

Unit/Apt: Street Number and Name:
City: Province: Ontario
Postal Code:

Contact

Primary Telephone:  Home Mobile Other

Area Code* Tel. number* ext:


Alternate Telephone:  Home Mobile Other

Area Code Tel. number ext:



E-mail Address:

Education

Select your highest level of education completed:*

 Grade 0 - 8 Grade 9 Grade 10 Grade 11 Grade 12 (or equivalent) OAC Certificate of Apprenticeship Journeyperson Certificate/Diploma Applied Degree Bachelor's Degree Post Graduate
Institution of highest level of education completed:*
Start Date:*
End Date:*
Type:*  Full-Time Part-Time
Country of Institution:*
Program Description:*

Additional Education

 Some Apprenticeship Some College Some University
Institution of additional education (may or may not have been completed):
Start Date:
End Date:
Country of Institution:
Program Description:

Are you interested in free academic upgrading for math, reading comprehension and writing?  Yes No

Employment

Employment Type:  Paid Self-Employed Unpaid Volunteer
Name of Employer:
Job Title:
Country of Employment:
Employment Start Date:
Employment End Date:
Wage Amount: Per:  hour week bi-weekly month year
Employment hours per week: Reason for leaving:

Additional Employment

Employment Type:  Paid Self-Employed Unpaid Volunteer
Name of Employer:
Job Title:
Country of Employment:
Employment Start Date:
Employment End Date:
Wage Amount: Per:  hour week bi-weekly month year
Employment hours per week: Reason for leaving:

Additional Employment

Employment Type:  Paid Self-Employed Unpaid Volunteer
Name of Employer:
Job Title:
Country of Employment:
Employment Start Date:
Employment End Date:
Wage Amount: Per:  hour week bi-weekly month year
Employment hours per week: Reason for leaving:

Additional Information

How did you hear about this program?
What are your short-term employment/career goals?

What are your long-term employment/career goals?

What types of work are you interested in doing? (List by order of preference)

Identify any necessary adjustments or accommodations at a job location, e.g. access and or equipment needs that may be required due to a health issue or disability .

Have you applied for Employment Insurance Benefits in the past 52 weeks?*  Yes No Unsure
If "Yes" where?

Attach your resume:


Notice of Collection and Consent

Your Service Provider delivers Employment Service under an agreement with the Ministry of Advanced Education and Skills Development (Ministry) and is required to make its books and records available to the Ministry for inspection, investigation or audit. Your Service Provider is also required to report to the Ministry on:

  • the service it tailors and provides to you
  • your educational, training and employment progress and outcomes
  • your satisfaction with the service you receive

The Ministry will also collect relevant personal information from Canada if necessary to determine your eligibility for and the nature and level of Employment Insurance benefits and to monitor, assess and evaluate the effectiveness of Employment Service. Depending on the type of service or support you receive and any incentives available to your employer to hire you, the Ministry may also collect personal information indirectly from your employer.

The Ministry will use your personal information to administer and finance Employment Service. For purposes of administering the Employment Service, client information collected on this form will be recorded, either by the Service Provider or Ministry, in the Ministry’s Employment Ontario Information System (EOIS). EOIS is used by the Service Provider and Ministry to support the administration of Employment Ontario programs and services, including the Employment Service. Note: The Ministry may use contractors and auditors to administer and finance Employment Service.
Administration includes:

  • Assessing the performance of your Service Provider – its effectiveness, efficiency and customer service results; monitoring, inspecting, investigating, auditing and enforcing your Service Provider’s compliance with its agreement with the Ministry;
  • Planning, evaluating and monitoring Employment Service – this includes conducting surveys; and conducting policy and statistical analysis and research related to all aspects of Employment Service. You may be contacted to request your voluntary participation in surveys.
  • Promoting Employment Service – You may be contacted to request your voluntary participation in public relations campaigns related to Employment Service.

Employment Service is funded by the Ministry, in part with funds provided by Canada under Part II of the Employment Insurance Act. Under the Labour Market Development Agreement between Canada and Ontario (LMDA), the Ministry is required to collect your social insurance number to provide reports to Canada to allow it to monitor and assess the Employment Insurance Program as required under s. 3 of the Employment Insurance Act. For example of such a report, see: http://www.hrsdc.gc.ca/eng/employment/ei/monitoring_assessment/index.shtml.
The Ministry collects your personal information in accordance with s. 38(2) of the Freedom of Information and Protection of Privacy Act, R.S.O. 1990. c. F.31, as amended, the LMDA, the Labour Market Agreement between Canada and Ontario, ss. 3, 63 and 139 of the Employment Insurance Act, S.C. 1996, C.23, as amended, s. 76.29 of the Employment Insurance Regulations, SOR/96-332, ss. 10, 34(1) and 36(1) of the Department of Human Resources and Skills Development Act, S.C. 2005, C.34 AND S. 8 OF THE Privacy Act, R.S. 1985, c. P-21, as amended.

For more information about the collection and use of your personal information to administer and finance Employment Service you can contact the Manager, Employment Ontario Hotline, in writing at the Ministry of Advanced Education and Skills Development, 33 Bloor Street East, 2nd Floor, Toronto, Ontario M4W 3H1 or by phone at 1-800-387-5656. http://www.edu.gov.on.ca/eng/tcu/threeWays.html.


By checking below, I give consent to the Ministry to indirectly collect, use and disclose my personal information for the purposes outlined above.

I acknowledge that the use of my personal information has been explained to me.
 Parent/Guardian (if applicant is under 16)

By checking below, I acknowledge that my Service Provider has explained its use and disclosure of my personal information for its purposes.

I confirm and accept the terms outlined above.
 Parent/Guardian (if applicant is under 16)

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