First Name *

Last Name *

Email *

Phone *

Date of birth *

Address *

City *

Postal code *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

When did you immigrate to Canada? *

Employment Status *

Would you be available to attend online from 9am – 1pm, Monday to Wednesday? *

Yes

Would you be available to attend 5 weeks of training in a hybrid model from 9 am – 5 pm, Monday to Friday? *

Yes

Do you have any of the following? *

Active Employment Insurance

BCEA PWD

BCEA Non-PWD (Income Assistance/ Welfare)

None of the above

Which industry are you interested in working? *

Retail

Warehouse

Other

How did you hear about this program? *

Emergency Contact (Full Name) *

Emergency Contact Number *

Relationship *

Upload Resume *

Upload Grade 12 Canadian High School

Upload Government Picture ID with proof of age of 19+ *

Consent *

Your personal information will be collected for determining your potential to participate in this project. If you have any questions about the collection of this personal information, please contact PICS Vancouver Office at 604-324-7733 or surrey office 604-596-7722. This information is being collected by Progressive Intercultural Community Services Society under Freedom of Information and Protection of Privacy Act (FOIPPA), section 26." I accept to be added to the waiting list of applications, and understand that my application will be reviewed and assessed on a first come first served basis. 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) Information regarding my training, employment history, and needs. (2) Information regarding my progress and follow-up results. (3) Attendance at scheduled interviews and interventions at the above agencies. (4) 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.