Register as a Candidate

Register as a Candidate
Are you filling out this form on behalf of the applicant (for example, your child)?

YesNo, I am filling it out for myself
Please fill out YOUR details and indicate your relationship to the participant:
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
What is your relationship to the candidate?*

ParentCaregiverFriendOther
Please advise if the candidate have attended a Jake's House Employment Expo:*

YesNo
Please advise if you have attended a Jake's House Employment Expo:*

YesNo
Please provide CANDIDATE'S personal information:
Please provide YOUR personal information:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
E-mail*
example@example.com
Birth Date*

MonthDayYear
Date
Are you eligible to work in Canada? According to the Government of Canada, to be eligible, you need a valid work permit, have the status of landed immigrant, permanent resident or be a Canadian citizen.*

YesNo
Please select your DSO Region*

Central East (Durham, Haliburton, Peterborough, Simcoe)Central West (Halton, Peel, Waterloo, Wellington)Eastern (Ottawa, Renfrew)Hamilton Niagara (Brantford, Hamilton, Niagara, NorfolkNorth East (Muskoka, Nipissing, Parry Sound, Timiskaming)Northern (Dryden, Sault Ste. Marie, Sudbury, Thunder Bay)South East (Frontenac, Hastings, Lanark, Prince Edward)South West (Chatham-Kent, Essex, Windsor, London, Oxford)Toronto (Etobicoke, North York, Scarborough, Toronto)I live outside of Ontario
Which of the following diagnoses do you identify with? (Select all that apply)*

AutismPDD-NOSADHD/ADDOCDAnxietyMental HealthI prefer not to label my diagnosisNone of these specific labels but I face barriers to employmentNot diagnosedDo not knowOther
Please select any barriers you face to finding meaningful employment Opportunities (select all that apply)?*

AgeEducationNo high school diplomaGaps in the employmentDisabilityLong termSocial service recipientNoneOther
Comment
Are you currently a student?*

Yes, Full-TimeYes, Part-TimeNo
Describe area of study*
In addition to earning money, what is your motivation to get a job (select all that apply)?*

Build self-esteemLearn new skillsBuild independanceDecrease anxietyImprove quality of lifeImprove physical healthMeet new peopleOnly earn moneyOther
Are you currently employed?*

YesNo
In your past experience at school or work, has there been anything specific that has been a challenge for you (select all that apply)?*

SoundsLightsSmellManagersCo-workers/ClassmatesCustomersPhone callsOpen work spaceLack of challengeLack of self-confidenceTemperatureNothingDo not knowOther
Any restriction in mobility or accommodations needed to be successful in a training or work environment?*

Cannot work shift workLifting restrictionsOther
Level of Support Required for Employment*

Full Mentor Support throughout employmentOccasional Mentor Support at beginning of employmentNo Support needed other than on the job training
What industries would you be interested in? (please select all that apply)*

FinanceConstructionSkilled TradesRetailSecurity (ie. Manned guard program or cyber security)Computer and technologyLawHospitalityTransportationManufacturingHealthcareOther
Would you be interested in participating in the complementary 4-week Jake’s House Skills Development Training Program (including transportation)?*

Yes, please connect with meNo, thank youMaybe, please tell me more
Would you be interested in participating in a complimentary Construction Craft Worker Pre-Apprenticeship Training or a Security Guard Training Program?*

Yes, please connect with meNo, thank youMaybe, please tell me more
How do you typically communicate?*

Verbal: spoken sentencesVerbal: phrases and wordsNon-verbal: uses a device (e.g. computers), pictures or sign languageMinimal Communication: may use vocalizations
Please upload your most recent version of your resume if you have one.

Cancelof
Where did you hear about Jake's House?*

FacebookInstagramWebsiteE-mailCallWord of mouthOther
Would you like to join the Jake's House mailing list?*

YesNo, thank you
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