Participant Application Form
/
EDUCATION & TRAINING
/Participant
Name: / First Name / Surname
Address:
Number & Street / City / Town / Postal Code
Telephone: / D.O.B.
dd/mm/yyyy / S.I.N.
Gender: / FEMALE MALE / Language Spoken: / Language Written:
Email Address: / Marital Status: / Number of Dependents:
Please specify your Aboriginal ancestry:
Métis / Inuit / Status First Nation / Non – Status First Nation
Which Aboriginal Organization, Band, or Metis Community are you with?
Are you: / Employed / Unemployed / Student
Type of Income Benefit: / Ontario Works
ODSP Disability / Other Agency
Are you currently in receipt of EI? / Yes No / If yes, Start Date:
Have you been on E.I. within the last three years regular benefits? / YES / NO / Approx. Date:
Have you been on E.I. within the last 5 years paternity / maternity benefits? / YES / NO / Approx. Date:
Do you have any health or disability issues that would have an effect on your employment and / or training? / Yes / No
If yes, please specify: / Addiction Hearing Intellectual Physical Visual
HIGHEST LEVEL OF EDUCATION:
High School / Year / Level Completed / Program:
College / Certificate or Diploma / Program:
Apprenticeship / License / Trade Cert. / Program:
Additional Training programs attended over the last three years:
Driver’s License: / YES / NO / Type: / Own / Use of Vehicle: / YES NO
If you do not have access to a vehicle, how will you ensure daily transportation?
EMPLOYMENT HISTORY PAST YEAR
Number of weeks worked in past year? / Number of jobs held in past year? / Pay rates for jobs in past year?
Most Recent Employer:
(Company, Job title, years of experience, reason for leaving)
Did you complete your Occupational Research Questionnaire
and provide a Resume / Occupational Research Questionnaire Resume
YES NO YES NO
Are you enrolled in other any other training opportunities (such as Second Career) YES NO
If yes, please describe: ______
How would you rate your interest level in working in the Hospitality and Tourism Sector? Please select one.
Not sure, will know better after the training
About 50/50
Probably
Definitely interested
Not interested
What type of Hospitality and Tourism work are you pursuing?
______
Are you willing to relocate upon completion of your training or for employment purposes? Yes No Maybe
*Please note, specific occupation choices may require relocating.
Where? ______
I first learned about The Navigating Employment Pathways Program from:
Radio Website Ad in Newspaper Friend/Family Other: ______
I hereby authorize the release of information from the identified affiliated agency pertaining to employment and/or training purposes by The Navigating Employment Pathways Program
Name of Agency: ______
Contact name: ______
Telephone number: ______
Client Confidentiality and Consent Form for The Navigating Employment Pathways Program
The information is collected under the authority of the Aboriginal Skills and Employment Training Strategy. It is used to determine program eligibility, to conduct program evaluation and to fulfill contractual obligations with Human Resources Skills Development Canada (Service Canada), and will be shared with Canada. The Metis Nation of Ontario may disclose such information where we are legally authorized to do so. The Metis Nation may also collect information as necessary throughout the client case management from other Service Providers that are pertinent to client case management. The Metis Nation of Ontario is working in partnership with The Ontario Tourism Education Corporation (OTEC) and The Canadian Tourism Human Resource Council. Any personal information will only be shared with program staff and its partners for the purpose mentioned above. All information collected will be kept strictly confidential and will be protected.
Information, when provided to Canada, is protected under Canada’s Privacy Act. Under the Privacy Act you have a right to access that information. To access information held in your personal file by the Metis Nation of Ontario please contact Beverley Newton, MNO’s Privacy Officer at 500 Old St. Patrick, Ottawa, Ontario K1N 9G4, 613-798-1488 or 1800-263-4889.
Client Authorization Form (to be completed by the client and, if applicable a legal representative)
I, the undersigned, have read and understand the form. I acknowledge that the information provided by me is true and accurate. I do hereby consent to the disclosure and/or use of my personal information by Metis Nation of Ontario Education Training Branch and HRSDC/ Service Canada.
______
Signature Date
1