First Name
*
Last Name
*
Phone
*
Email
*
Your Residency Status in Canada
*
Canadian Citizen
Permanent Citizen
Protected Person- Legally Approved
Are you Indigenous?
*
Yes
No
Are you residing in British Columbia?
*
Yes
No
Address
*
City
*
Postal code
*
Are you 19 years or above?
*
Yes
No
Are you a high school graduate?
*
Yes
No
Do you meet English Language criteria equivalent to CLB 6?
*
Yes
No
What is your current employment status?
*
Employed
Unemployed
If Employed:
*
fully employed (>= 30 hours/week)
underemployed (<30 hours/week)
Are you currently receiving Employment Insurance (EI)?
*
Yes
No
Are you on Maternity EI?
*
Yes
No
Have you taken an English language proficiency test ? If Yes, mention the name of the test and score
*
Did you attend any free training programs in 2021 and 2022?
*
Yes
No
If yes, in which program and at with which organization/institution?
Will you commit to attending all classes according to the college schedule throughout the training period?
*
Yes
No
Will you commit to attending the practicum where your placement is set up by the college to finish the training program?
*
Yes
No
Consent
*
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.
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