First Name
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Last Name
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Email
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Phone
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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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Which region do you currently reside in?
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Metro Vancouver
Fraser Valley
Thompson Okanagan
Vancouver Island
Gender
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Male
Female
Other
Do you self-identify as:
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Indigenous Person
Caucasian
Black
Asian
South East Asian
Latino
Arab
Age group
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18 - 30
31 - 50
51 - 65+
Education Level
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High School
College
University
Legal status in Canada?
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Permanent Resident
Citizen
Open Work Permit
Student Visa
Refugee With Court Decision Notice
Ukrainian CUAET
Employment Status
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Full time
Part time
Student
Casual/ On Call
Unemployed
Are you receiving any financial support?
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EI
PWD
Income Assistance
None of the above
English Language Proficiency
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Beginner
Intermediate
Advance
Native
Besides English, which other language do you speak?
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Would you be available to attend online and in -person (Lower Mainland) classes for full-time hours from 9 AM to 5 PM, Monday to Friday?
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Yes
No
How did you hear about this program?
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Do you have access to a reliable laptop or computer with internet to attend all virtual classes in the program?
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Yes
No
Would you be able to work full time after completing the program?
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Yes
No
Are you self-identified and fit in 1 or more of the following status?
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Visible Minority (Women, non-white in colour, or LGBTQ2+), Immigrant, and/or Refugee
Young Adult at Risk
Older Worker
Survivor of Violence and/or Abuse
Person with Disabilities
Housing instability (currently not own any properties)
Recovering from addiction
Mental health challenges
Lack of recent and/or Canadian work experience
Lack of basic employment skills
Limited literacy, financial literacy, or digital literacy skills
Limited English language skills
Having less than a Grade 12 education (or No High School Graduation in Canada)
Upload Resume
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Consent
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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.
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