CSETS Participant Information Form

Social Insurance Number(Required)

Gender(Required)

Marital Status(Required)

Number of Dependents(Required)

Aboriginal Type(Required)

Status Number(Required)

Band(Required)

Language Spoken(Required)

Job Title(Required)

Employer(Required)

Grade(Required)

School Name(Required)

Job Title(Required)

School Name(Required)

Grade / Year Level(Required)

Program(Required)

Start Date(Required)

End Date(Required)

Highest Level of Education(Required)

Year Attained(Required)

Write N/A if not applicable

Post-Secondary(Required)

Year Attained(Required)

Write N/A if not applicable.

Education Province(Required)

Primary Phone(Required)

Alternate Phone

Email(Required)

What is your Job/Career interest?(Required)

Other Barriers(Required)

My signature below means:

I have answered all questions on this form and certify that all information I have provided is complete accurate and true. I understand Coast Salish Employment & Training Society and/or its Member Organization receives funding for this program from the federal government as a result of the Canada Indigenous Skills & Employment Training Strategy (ISETS) Agreement Holder.

I understand that the information provided on this form or that has been collected about me during my participation in this program will be forwarded to the HRSDC/Service Canada for evaluation purposes and reporting requirements as per signed ISETS Agreement.

I consent to being contacted by HRSDC/Service Canada (or its agent) and up to 12 months after completion of my participation in this program for the purpose of program evaluation. I consent to the information I have provided on this form being shared with potential employers for assessment in job readiness.

I understand that once signed, this document becomes a protected document under the Personal Information Protection and Electronic Documents Act or similar applicable provincial legislation.

Collection and Use of Information. All information is collected pursuant to section 26() of the Freedom of Information and Protection of Privacy Act. The information provided will be used for administrative and evaluation purposes of this program.

Signature

Date Signed

CSETS PIF Form