New Employment Services Form

Participant Address and Contact Information
Primary Mailing Address
Unit Number
Street Number*
Street Name*
PO Box
City/Town*
Province*
Postal Code*
Alternate Mailing Address
Alternate Unit Number
Alternate Street Number
Alternate Street Name
Alternate PO Box
Alternate City/Town
Alternate Province
Alternate Postal Code
Primary Phone Number

HomeMobileOther
Telephone Number
ext.
Alternate Phone Number

HomeMobileOther
Alternate Telephone Number
ext.
Do you have an email address?*

YesNo
Email Address

Additional Information
How did you hear about this program?
What are your short-term employment/career goals?
What are your long-term employment/career goals?
What type of work are you interested in doing?
Identify any necessary adjustments or accommodations at a job location?
Have you applied for Employment Insurance Benefits in the past 52 weeks?

YesNoUnsure
If "Yes", where?

Notice of Collection and Consent
Your organization delivers Employment Services under an agreement with the Ministry of Labour, Training and Skills Development (Ministry) and is required to make its records available to the Ministry for inspection, investigation or audit. Your organization is also required to report to the Ministry on:
- the service it tailors and provides you;
- your employment progress and outcome; and
- your satisfaction with the services you receive.
The Ministry will also collect relevant personal information about you from the Government of Canada (Canada) if necessary. The purpose of this information is to determine your eligibility for Employment Insurance benefits, the nature and level of Employment Insurance benefits, and to monitor, assess and evaluate the effectiveness of Employment Services. Depending on the type of service or support you receive and any incentives available to your employer to hire you, your organization or the Ministry may also collect personal information about you from your employer.

The Ministry may use contractors and auditors to administer and finance Employment Services.

Administration includes:
- Assessing the performance of your organization – its effectiveness, efficiency and customer service results; monitoring, inspecting, investigating, auditing and enforcing your organization’s compliance with its agreement with the Ministry.
- Planning, evaluating and monitoring Employment Services – this includes conducting surveys, and conducting policy and statistical analysis and research related to all aspects of Employment Services. You may be contacted to request your voluntary participation in surveys.
- Promoting Employment Services – you may be contacted to request your voluntary participation in public relations campaigns related to Employment Services.
If you are a client of, or applying to, the Ontario Disability Support Program or Ontario Works, the Ministry will provide your personal information to the Ministry of Children, Community and Social Services (MCCSS) for the purposes of administering employment services and managing the participation of MCCSS clients in employment support programs under the Ontario Works Act, 1997, and the Ontario Disability Support Program Act, 1997.

Employment Services is funded by the Ministry, in part with funds provided by Canada under Part II of the Employment Insurance Act. When funds are provided by Canada, the Ministry is required to provide information to Canada to help monitor and assess the Employment Insurance Program, as required under s.3 of the Employment Insurance Act. Under the Labour Market Development Agreement between Canada and Ontario (LMDA) and the Workforce Development Agreement between Canada and Ontario (WDA), the Ministry is required to collect your social insurance number.

The Ministry collects your personal information pursuant to the LMDA and WDA, ss. 3 and 63 of the Employment Insurance Act, S.C. 1996, C.23 as amended, and s.76.29 of the Employment Insurance Regulations, SOR/96-332. The Ministry will collect personal information from clients who identify as Ontario Disability Support Program or Ontario Works recipients and disclose your personal information to MCCSS in accordance with the s.71 of the Ontario Works Act, 1997, and s.53 of the Ontario Disability Support Program Act, 1997.

For more information about the collection and use of your personal information to administer and finance Employment Services, you can contact the Manager, Employment Ontario Call Centre, in writing at the Ministry of Labour, Training and Skills Development, 33 Bloor Street East, 2nd Floor, Toronto, Ontario M7A 2S3 or by phone at 1-800-387-5656. For the hearing impaired, TTY is available at 1-866-533-6339.

Signatures

By signing below, I acknowledge that my Service Provider has explained its use and disclosure of my personal information for its purpose
Participant's Name*

First NameLast Name
Participant's Signature*

Clear
Participant Signature Date*

DayMonthYear
Date
Is applicant under 16 years of age?*

YesNo
Parent/Guardian's Name

First NameLast Name
Parent/Guardian's Signature

Clear
Parent/Guardian Signature Date

DayMonthYear
Date
By signing below, I give consent to the Ministry to indirectly collect, use and disclose my personal information for the purposes set out above.
Participant's Name*

First NameLast Name
Participant's Signature*

Clear
Participant Signature Date*

DayMonthYear
Date
Parent/Guardian's Name

First NameLast Name
Parent/Guardian's Signature

Clear
Parent/Guardian Signature Date

DayMonthYear
Date

Privacy Statement
Statement of Confidentiality

The Labour Education Centre (LEC) is committed to respect of the individual, which includes the maintenance of client confidentiality. However, the confidentiality of the staff member-client relationship is not absolute. In these circumstances, it is the LEC staff member’s duty to disclose client information throughout the course of their staff-client relationship. There are four different ways in which such a duty may arise:
1. The requirements by law to disclose information through a court order subpoena or search warrant.
2. The client reveals a significant risk of injury or death to him/herself or someone else.
3. The client gives verbal and written consent as outlined in the “Consent to the Release of Confidential Information” section of this document.
4. Mandatory Reporting Obligations, where the client discloses information previously unreported, regarding the abuse of a child under the age of 16.
Consent to the Release of Confidential Information

I understand my rights to confidentiality when participating in a LEC Employment Services program. Its intention is to provide you with a safe environment where you are free to share information knowing that it will not be passed on to others besides the staff of the Labour Education Centre and its funder, the Ministry of Labour, Immigration, Training and Skills Development (MLITSD). However, the need may arise for information to be shared with other agencies for the purpose of developing an employment or educational service plan.

Questions about the collection of this information may be addressed by email to fsamji@laboureducation.org or by phone at 416-537-6532 ext. 2219.

I agree to receive emails from LEC staff for the purpose of job searching. I agree that my resume and cover letter may be sent to employers by LEC staff for the purpose of helping me gain employment.

By signing below, I agree that an employment service plan (ESP) will be opened for me at the time of registration to help me reach my goal(s). This is YOUR employment service plan outlining steps identified to help you reach your goal(s). This Employment Service Plan can be modified. This information shall be protected in accordance with legislated requirements.
Participant's Name*

First NameLast Name
Participant's Signature*

Clear
Participant Signature Date*

DayMonthYear
Date
Should be Empty:

LEC Employment Services Form

Service Provider Use Only

Participant Details

Participant Address and Contact Information

Primary Mailing Address

Alternate Mailing Address

Education

Employment

Work Experience 1

Service Provider Use Only (1)

Work Experience 2

Service Provider Use Only (2)

Work Experience 3

Service Provider Use Only (3)

Additional Information

Client Summary

Notice of Collection and Consent

Signatures

Privacy Statement