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First Name
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Last Name
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Phone
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Email
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Date of birth
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Address
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City
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Postal code
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Legal Status in Canada
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Citizen
Permanent Resident
Employment Insurance (Select all that applies)
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Active Regular (EI)
Reach back (Regular EI in the past 60 Months)
Have worked full-time for any 5 years out of the last 10 years in Canada Earned more than $2000 in insurable earnings and paid employee EI
Income Assistance (BCEA – Non-PWD)
BCEA – PWD
Not Sure
None of the Above
Employment Status
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Full-Time Employed
Part-Time Employed (less than 20 hours a week)
Part-Time Employed (more than 20 hours a week)
Casual/On Call
Unemployed
Would you be available to attend online and in -person (Lower Mainland) classes from 8:30am – 5pm, Monday to Friday?
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Yes
No
Are you registered at Work BC?
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Choose an option
Yes
No
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If Yes, where is your Work BC centre located?
Case Manager's Name
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Case Manager's Phone Number & Email
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How did you hear about the Program?
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Service Canada Office
Walk in
Internet
Community Centre
Neighbourhood House
Friends/Family
Previous Client
Service Provider
Whatsapp Group
Telegram Group
Facebook Group
LinkedIn Group
English Language Proficiency Level. Please indicate any valid English Language Test proof you have that was taken within the last 4 years
IELTS: 5.5 (or better)
TOEFL (paper): 520 (or better)
TOELF (CBT): 190 (or better)
TOEFL (IBT): 70 (or better)
Cambridge: CAE (or better)
Canadian High School Diploma
English 12 graduation certificate from a Canadian high school
Canadian LINK or ELSA program level 4 certificate
CELPIP (Canadian English Language Proficiency Index Program) 3H or better
CLB (Canadian Language Benchmark) 6 or better
Pre-Intermediate (or better) Certificate from a Language Canada accredited school
Pre-Intermediate (or better) Certificate from any language school accredited by local authorities worldwide
Two years study in an English program that leads to a degree worldwide
BA, MA or PHD in English Language from a university worldwide
TESOL, CELTA or DELTA certification
Lived and worked in an English-speaking country longer than 10 years
Spent at least two years study,ing in a secondary, post-secondary or higher education school in any program in a system where English is the official language of instruction
Passed ITD Canada's English Assessment Test (online with a proctor or in person) at the pre- intermediate level
Currently do not have an English Language proficiency proof.
Will you commit to attending all classes according to the college schedule throughout the training period?
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Yes
No
Will you commit to attending the practicum where your placement is set up by the college to finish the training program?
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Yes
No
Emergency Contact
Full Name (EC)
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Relationship
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Emergency Contact
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Upload Resume (Optional)
Consent
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I, authorize Progressive Intercultural Community Services Society (PICS), any other service providers, schools, and community agencies to disclose/exchange my personal information, including the usage of my photo and /or video in the following: (1) My eligibility for Employment Benefit Programs for the Ministry of Social Development, Province of British Columbia. (2) Information regarding my training, employment history, needs, and income support. (3) Information regarding my progress and follow-up results on my Action Plan. (4) Attendance at scheduled interviews and interventions at the above agencies. (5) Information regarding marketing of the program. The information disclosed/exchanged will be treated as confidential and will be used only by the agencies listed above in conjunction with your application for service. I agree to also receive marketing and promotional emails and newsletters from PICS regarding upcoming education and training programs.
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