ISETP Client Services Application Form

Indigenous Skills & Employment Training Program New Brunswick Aboriginal Peoples Council

320 St.Mary’s Street Fredericton, NB E3A 2S4 Tel: (506)458-8422 Toll Free: 1-800-442-9789 Fax: (506)451-6138

www.nbapc.org Collection of Personal Information - The information collected in this application is required to determine the applicant's eligibility

For assistance under the ISETP program and will be provided to Canada for the purposes of determining EI eligibility, uploading of data to Canada's data system, and evaluation and assessment of the ISETP funding program. Information collected will not be disclosed to any person or body for a purpose other than that for which is was provided.

(If yes, check all boxes below that apply)

Intervention Information - Training institution, company or organization:

Please Upload the following documentation if you have it. Documentation can be sent at a later date once an Employment Counsellor has been assigned to your application.

- Proof of Aboriginal ancestry (i.e. photocopy of Indian status cardIf proof is not available, contact ISETP

- Resume with three references

- Letter of acceptance to training institution, or job offer/letter of intent to employ

- Printout or letter of training institutions costs for tuition, books, fees and equipment/supplies*

Providing false or misleading information will be cause for termination of participation in the Indigenous Skills and Education Training Program and the recouping of any funds provided. I solemnly declare that all the documents and statements made in this application are true.

By typing your name and selecting SUBMIT APPLICATION at the end of this form you accept the terms and conditions set out below for Client Consent, Training and Education Contract, Client Authorization and Photo and Success Story Consent Release Form.

Under the authority of the Employment Development Act, S.N.B. 2011, c.148, the Department of Post-Secondary Education, Training and Labour (the Department) collects, accesses, uses, discloses and protects information provided by you in accordance with section 46(1a) of the Right to Information and Protection of Privacy Act, SNB 2009, c. R-10.6 (RTIPPA); section 37(1) of the Personal Health Information Protection and Access Act, SNB 2009, c. P-7.05 (PHIPAA); and the Department’s Document and Record Management Policy for the purposes of administrating programs and services.

I allow the Department, its agents, and service providers to collect only as much personal information as is reasonably necessary and use my information for the following purposes To determine and verify my eligibility and/ or participation in the program/ service for which I am applying and/or receiving; To assist me in attaining my employment /business /training /academic upgrading goals, which includes monitoring my progress and any preand/or postassessments; and To administer programs and services To contact me both during and for a period of up to seven (7) years following my participation in the program/service to monitor and evaluate my employment/training status. I consent to receive text messages, when applicable, on my cell phone provided in the application. I understand that standard or higher text messaging rates may be applied

I understand that in order to accomplish these purposes, my information may need to be shared. I hereby consent to allow the Department, its agents and externalservice providers to disclose my information if and when necessary to other branches within the Department; other New Brunswick provincial departments; federal government departments as per information sharing agreements; eligible employers; and thirdparty researchers/evaluators.

I understand that I can cancel my consent in writing at any time and in doing so I understand that I will no longer be able to participate in the program/ service because of its administrative requirements and the requirements established by the Canada-New Brunswick Labour Market Agreements and in accordance with the RTIPPA.

I have read the above information in its entirety. I understand that all information provided by me must be accurate; and that I am responsible to immediately notify the Department, its agents and service providers of any changes. I acknowledge that this authorization is valid for the duration of the program(s) or service(s) and the monitoring associated with it, and to carry out the evaluation of the programs(s) or service(s) as established by the Department of Post-Secondary Education, Training and Labour.

If you have any questions regarding how your personal information is collected or used, you may contact the Program Officer/Consultant/Employment Counsellor at the Department of Post-Secondary Education, Training and Labour in your region. A list of all departmental Employment Development offices and their contact information can be found online at: www.snb.ca/PETLContact

Funded by the Governments of Canada and New Brunswick through the Canada-New Brunswick Labour Market Agreements

320 St.Mary’s Street Fredericton, NB E3A 2S4 Tel: (506)458-8422 Toll Free: 1-800-442-9789 Fax: (506)451-6138

1. I agree to attend the above Educational Institutional for the period set out in my acceptance letter.

2. I agree to advise the training institution and my Employment Counselor of any days that I cannot attend and state the reasons why.

3. I agree to contact my Employment Counselor at the end of every month.

4. I will submit my completed attendance sheet, on a monthly basis, to my Employment Counselor.

5. I agree to advise my Employment Counselor of any problems arising concerning my training.

6. I am aware that all funding I receive, or paid on my behalf, is taxable income and I will receive a T4(A) Form after the new year.

7. I authorize the NBAPC - ISETP to access information pertaining to my employment, EI Status, Social Assistance status, training and education.

In the event of a breach of the agreement and/or the failure to adhere to the non-financial conditions (items 1 - 7) may result in the right to terminate the agreement.

• The individual may be required to repay the amount of any financial assistance to which the individual is not entitled including:
• the amount of any payments made to the individual in error
• the amount of any payments made for costs in excess of the amount actually incurred by the individual for those costs
• the amount of any payments that were used for costs that were not eligible for reimbursement under the agreement.

Payment of any financial assistance under the agreement is subject to the availability of funds provided by Canada to the Council and that payment of financial assistance may be cancelled or reduced in the event that Canada cancels, reduces or decides not to renew its funding to the Council.

Payment of any financial assistance is liable for repayment if the agreement is terminated without a valid reason.

I have read and agree to the above Terms and Conditions.

I, the undersigned, being the participant under the Aboriginal Skills & Employment Training Strategy, authorize the NBAPC-ISETP (New Brunswick Aboriginal Peoples Council - Indigenous Skills & Employment Training Program, Service Canada, Dept. Of Post-Secondary Education Training and Labour) to access information pertaining to my employment, EI status, Social Assistance status, training and education. Further, I hereby give permission for my training institution &/or employer to release any information related to my training, work placement and case plan (grades, attendance, workplace issues, etc to my Employment Counselor.

I, the undersigned, hereby authorize and direct the NBAPC-ISETP to pay any fees in relation to my NBAPC-ISETP contract directly to my training institution, licensing association, employer, etcon my behalf.

I, the undersigned, certify that the information provided in this document (Pages 1-5 sections A- F) is true and correct to the best of my knowledge. I also authorize the NBAPC-ISETP, Service Canada, Dept. Of Post-Secondary Education Training and Labour to utilize my information and also access additional information pertaining to my employment, training and education. I certify that I understand the conditions outlined above in Section F: Client Authorization and agree to them.

320 St.Mary’s Street Fredericton, NB E3A 2S4 Tel: (506)458-8422 Toll Free: 1-800-442-9789 Fax: (506)451-6138

hereby consent to my photographs and successy photographs and success story information to be used in any editorial and/or promotional material produced and/or story information to be used in any editorial and/or promotional material produced and/or published by the New Brunswick Aboriginal Peoples Council & ISETP.published by the New Brunswick Aboriginal Peoples Council & ISETP.

I agree that these photographs and success story information will be the exclusive property of the

I agree that these photographs and success story information will be the exclusive property of the New Brunswick Aboriginal Peoples Council & ISETP, the reproduction rights are handed over to New Brunswick Aboriginal Peoples Council & ISETP, the reproduction rights are handed over to the New Brunswick Aboriginal Peoples Council & ISETP to use the photos and success story the New Brunswick Aboriginal Peoples Council & ISETP to use the photos and success story information in any medium in perpetuity.information in any medium in perpetuity.

I understand that signing this release does not guarantee publication of the photo or success. 

I understand that there will be no compensation or remuneration for the use of the photo or I understand that there will be no compensation or remuneration for the use of the photo or success story success story information.

I have read and acknowledge that by selecting SUBMIT APPLICATION that I agree to and will abide with all conditions set out in this application.