Full Name
*
Phone
*
Email
*
Address
*
Postal code
*
City
*
Gender
*
Male
Female
Non-binary
Prefer not to say
New Immigrant (in Canada less than 5 years)
*
Yes
No
Prefer not to say
Immigration Status
*
Canadian Citizen
Permanent Resident
Refugee with work permit
Other
Are you over 16 years of age?
*
Yes
No
Visible Minority Group (if applicable)
Arab
Black
Chinese
Filipino
Latin American
Japanese
Korean
South Asian
West Asian
Prefer not to say
Indigenous Group (If Applicable)
Inuit
Métis
Non-status
Registered off-reserve
Prefer not say/decline to answer
What is your highest level of education in your life? (AES)
*
University certificate, diploma, or degree at the bachelor level or above
University certificate or diploma below bachelor level
College, CEGEP, or other non-university certificate or diploma
Apprenticeship or trades certificate or diploma
Secondary (high) school diploma or equivalent
No certificate, diploma, or degree
Prefer not to say
Employment Status
*
Employed
Unemployed
Student Full-time
Student Part-time
Self-employed
Prefer not to say/decline to answer
If applicable, how long were you employed?
Do you self-identify as having a permanent or recurring disability that is physical, mental or neurodevelopmental?
*
Yes
No
Prefer not to say/Decline the answer
Types of Disability
*
Agility
Developmental
Episodic (non-mental health related)
Hearing
Intellectual
Learning
Mental Health
Motor Skills
Speaking
Substance use disorder
Visual
Prefer not to say/decline to answer
Permanency of Disability
Permanent (a lifelong disability, where there is no reasonable chance for recovery)
Temporary (a disability, where there is a reasonable chance for recovery and is not expected to remain throughout your life)
Prefer not to say/decline to answer
Other Barriers to Employment
*
Addiction
Children with a disability
Child care
Housing
Social Skills
Transportation
Prefer not to say/decline to answer
How did you hear about this program?
*
PICS Website
Free Trainings Website
Email
Facebook
Instagram
LinkedIn
Family Member/Friend
WorkBC
Other Service Provider
Career Fair/Special event
Other
Emergency Contact Info
Primary Contact Name
*
Phone Number
*
Email
Relationship
*
Address
*
Secondary Contact Name
*
Phone Number
*
Email
*
Relationship
*
Address
*
Upload Government Photo ID
*
Upload Resume
Please write in a few sentences why you would like to join the program?
*
I authorize Progressive Intercultural Community Services (PICS) Society, to disclose and or exchange the following personal information with PICS’ program funders, with potential funders when PICS applies for funding for future programs, PICS agency partners, potential and future employers:
*
Program enrollment, participation and completion Contents of job applications including resumes and cover letters; Any references provided; and Contents of educational qualifications including degrees/diplomas/certificates/and certificates obtained during program
The information disclosed and or exchanged will be treated as confidential and will be used solely for PICS official purposes. Signing this Authorization is optional; however, refusal may affect your eligibility for employment and working with programs delivered by PICS. I understand that the records of information shared are available to me by application, through the privacy act, and that I may withdraw this consent at any time through a written request.
*
I authorize PICS to use my name, picture, and success stories for promotional purpose(s)
*
I agree to be placed on a wait list for future opportunities. I agree to receive promotional content from PICS which I can opt out of at any time.
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. 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. I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application or immediate termination of my application.
Submit