First Name
*
Last Name
*
Phone
*
Email
*
Address
*
City
*
Province
*
Postal code
*
Date of birth
*
Identity
*
Woman
Identify as a woman
Prefer to self describe
Please indicate your age group
*
18-40
41-65
Other
Number of dependants
*
No (1)
1 - Dependent (2)
2 - 3 Dependents (3)
4+ Dependents (4)
How do you Identify? (Check all that apply)
*
Newcomer to Canada
2SLGBTQIA+
Immigrants
Black Canadians
Racialized Persons
Young Adult at Risk
Indigenous People
Legal Status in Canada
*
Permanent Resident
Citizen
Refugee protected with court’s decision
common.other_option
Employment Status
Full time
Part time (less than 20 hours per week)
Part time (more than 20 hours per week
Student
Casual/ On Call
Unemployed
Languages Spoken
*
English
French
common.other_option
English Proficiency
*
Select an option
Highest level of Education Completed
Less than high school
High school diploma/equivalent
Trades Training
College/non-university certificate or diploma
University degree
common.other_option
Main source of Income
Employed
Employment Insurance(EI)
Maternity/Medical EI
Income/Social Assisstance
Disability Assistance
Single parent or Income assistance
Student
None
Which Trade are you interested in
Electrical
Construction Craft worker
Welding
Are you willing to complete the total of 6-8 weeks in person training?
Yes
No
Are you willing to complete 2-4 weeks of unpaid practicum with local employers?
Yes
No
Do you have a laptop?
*
Yes
No
I will arrange
Do you have prior experience working in the trades?
*
Yes
No
If yes, please specify
Do you have class 5 driver’s licence?
*
Yes
No
Are you able to perform tasks that include lifting up to 50 lbs?
*
Yes
No
How did you hear about this program?
*
Are you registered at Work BC?
If Yes, where is your Work BC centre located?
Case Manager's Name
Case Manager's Phone Number with Ext.
Case manager's email
Emergency Contact (Full Name)
*
Emergency Contact Number
*
Relationship
*
Emergency Contact (Full Name) 2
*
Emergency Contact Number 2
*
Relationship
*
Please Upload a copy of your Government issued ID (BC Driving Licence or BC Service Card)
Click to upload
Upload Resume
*
I agree to
terms & conditions
provided by the company. By providing my phone number, I agree to receive text messages from the business.
Consent
*
Your personal information will be collected for determining your potential to participate in this project. If you have any questions about the collection of this personal information, please contact PICS Vancouver Office at 604-324-7733 or surrey office 604-596-7722. This information is being collected by Progressive Intercultural Community Services Society under Freedom of Information and Protection of Privacy Act (FOIPPA), section 26; I accept to be added to the waiting list of applications, and understand that my application will be reviewed and assessed on a first come first served basis. I, authorize Progressive Intercultural Community Services Society (PICS), any other service providers, schools, and community agencies to disclose/exchange my personal information, including the usage of my photo and /or video in the following: (1) Information regarding my training, employment history, and needs. (2) Information regarding my progress and follow-up results. (3) Attendance at scheduled interviews and interventions at the above agencies. (4) Information regarding marketing of the program. The information disclosed/exchanged will be treated as confidential and will be used only by the agencies listed above in conjunction with your application for service. I agree to also receive marketing and promotional emails and newsletters from PICS regarding upcoming education and training programs.
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