First Name *

Last Name *

Phone *

Email *

Address *

City *

Province *

Postal code *

Date Of Birth

Legal Status in Canada *

Permanent Resident

Citizen

Refugee with Work Permit

Employment Insurance (Select all that applies) *

Active Regular (EI)

Reach back (Regular EI in the past 60 Months)

Have worked full-time for any 5 years out of the last 10 years in Canada

Earned more than $2000 in insurable earnings and paid employee EI premiums on those earnings in at least 5 of the last 10 years (Note: the 5 years do not have to be consecutive years)

Income Assistance (BCEA – Non-PWD)

BCEA – PWD

Not Sure

None of the Above

How do you meet the program's math requirement? *

I have successfully completed Math 10, Math 11, or Math 12 with a minimum grade of C (or equivalent) in Canada, and I can provide official transcripts or proof of completion.

I have not completed Math 10, 11, or 12 with a minimum grade of C, but I am willing to complete the Math Assessment.

How do you meet the program's English requirement? *

I have successfully completed 2-3 years secondary education in Canada, and I can provide official transcripts or proof of completion.

I have completed post-secondary education in English in a country where English is a principal language of instruction.

I have successfully completed an approved English language test (e.g., IELTS, TOEFL, CAEL, CELPIP) within the last 2 years and can provide valid test results as proof.

I do not meet any of the above requirements but I am willing to complete the English Assessment.

Do you have basic computer skills to complete online assignments and program requirements? *

Yes

Are you willing to complete the total of 21 weeks in person training? *

Yes

Are you willing to complete 4 weeks of unpaid practicum with local employers?

Yes

Are you registered at Work BC? *

Yes

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 2 (Full Name)

Emergency Contact Number 2

Relationship 2

Please Upload a copy of your Government issued ID (BC Driving Licence or BC Service Card) *