Key to Employment Program Registration

Indigenous Community for Leadership and Development

www.icldgroup.com
Key to Employment Program Registration
Confidentiality Agreement

We would like to disclaim that all information shared with us will be kept confidential and is solely for the use of ICLD’s Program Intake, we will not reproduce or circulate this information to anyone that was not mentioned in the below consent agreement. Thank you for your cooperation.
Consent Agreement

I consent to Indigenous Community for Leadership and Development Inc. sharing my personal information such as: Social Insurance Number, Date of Birth and Initials, with the Ministry of Social Development and Poverty Reduction, Employment and Labor Market Services Division for the purposes of establishing eligibility for the Project Based Labour Market Partnership Project “Key to Employment”. The information is collected under the authority of Section 26(C) of the Freedom of Information and Protection of Privacy Act(FIOPPA) and is subject to all of the provisions of that Act.
Recruitment

Employment Readiness, Certification courses, and Igniting Healing Workshop. Please complete this form with your contact details and you will be contacted by someone from our office to provide more information about the training course.
Please be sure to match the numbers at the beginning of the Course Name and Course Code fields to ensure that they are matched correctly. Thank you!
Course Name
Course Code
Legal Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal Code
Contact E-mail
example@example.com
Contact Number
Gender
Date of Birth

MonthDayYear
Date
Age Range
Do you identify as Indigenous?
Are You Currently Living on Reserve
Highest Level of Education
Marital Status
Full-time employedPart-time employedUnemployed - looking for work
Are you currently receiving EI?
For Personal Protective Equipment Purposes of the Program please provide your Shoe Size:
Will you be able to attend the full course?
Are you or have you been a youth in care?
Do you consider yourself a person with disabilities?
Emergency Contact 1

First NameLast Name
Phone
Emergency Contact 1's phone number.
Email
Emergency Contact 1's email address.
Relationship with contact 1
Who is this person to you?
Emergency Contact 2

First NameLast Name
Phone
Emergency Contact 2's phone number.
Email
Emergency Contact 2's email address.
Relationship with contact 2
Who is this person to you?
Do you have any allergies we should be aware of?
Is there anything else you'd like to share with us?
ICLD Facebook PageWorkBCFriendship CentreOther
If other, where?
We ask that through the Igniting Healing part of the program you have two people who could provide emotional support for you and or be your emergency contact person. Please supply their name, phone number, and email address too if you can.
Do you have any current problems that may interfere with your grief reactions?
Do you currently have any health problems that may interfere with your grief reactions?
Are you currently seeing a counsellor?
Should be Empty:

Indigenous Community for Leadership and Development

Key to Employment Program Registration

Confidentiality Agreement

Consent Agreement

Recruitment