Mississaugas of the Credit Employment & Training Intake

CLIENT PROFILE:

INDIGENOUS AFFILIATION:

LANGUAGES:

HIGHEST LEVEL OF EDUCATION ATTAINED:

ADDITIONAL INFORMATION:

Client Consent Form

I, {firstName}{lastName}  SIN: {sin} understand that the personal information

collected and held by 3670005 ISETS - Mississaugas of the Credit Employment and Training will solely be used to help me access employment services and benefits designed to help me prepare for, get, and keep employment.

By signing this consent, I understand that I am bound by the requirements of the contract which will be sent to me in a separate document upon approval of funding.

I hereby grant permission for any and all personal information held by 3670005 ISETS - Mississaugas of the Credit Employment and Training to be disclosed, when required, on an as needed basis to representatives of:

• Human Resources Development Canada and its successor departments and agencies
• The provincial Department of Human Resources and Employment and its successor departments and agencies, and
• Organizations under contract to either of these departments to provide employment related benefits and services (Ontario Works, Ontario Disability Support Program)
• Mississaugas of the Credit Employment & Training Board (Band number only)

ACTION PLAN (attach additional page if required)