Express to Success Application Form 2

In order for us to be able to get to know you and support you, please answer all of the following questions. When you have completed the form, you will be asked to sign it digitally. When you sign and submit the form, it will send you a copy for your records.

We will follow up regarding your application via email within 72 hours. Please check your email (including your spam/junk folders) regularly. 

EtS Application Form 2

Contact Information

Please enter this information again so we can keep all your applications in your records.
First Name
Last Name

Demographics

This section helps us to understand the demographics of our program participants and that helps us to improve and create new programs.
Gender
Have you been or are you a Youth in Care with Ministry of Children and Family Development?
Level of Education (Please the option that best describes your current situation)

Goals

This section helps us to understand your program goals.

Employment

This section helps us understand your job search needs.

Maximum file size: 516MB

What type of employment are you seeking? (Check all that apply)
In what areas would you like to have more assistance? (Check all that apply)

Support

This section of the form helps us understand your current supports.
I have enough income to meet my basic needs (Housing, Phone, Food, Utilities, Internet, etc.)
Are you in receipt of, or have you made an application to: EI and/or CERB/CRB
When did you last receive EI Benefits?

Experience

This section helps us get to know your employment experience.
This section helps us get to know your employment experience.

Education

This section helps us get to know your education and training experience.
I graduated grade 12
I have learning challenges

Housing & Transportation

This section helps us get to know your housing and transportation needs.
I have reliable transportation to/from work or job search
I have experienced physical or non-physical violence at home

Health

This section helps us get to know your health and wellness considerations.
I have been diagnosed with one or more of the following

Justice System

This section helps us get to know your experience with the justice system.

Other Information

Participant Consent

As part of your participation in the (Express to Success) program, personal information will be collected from you including but not limited to your name, social insurance number, contact and demographic information. Following completion of the training, all Participants are required to provide feedback about the program, the outcomes of the training, and whether the training met your employment needs ("Surveys"). You may also be asked if you wish to, or may volunteer to, provide a testimonial regarding your program experience ("Testimonial").

Collection Notice

All personal information in the Application (Participant Intake) form, the Surveys, any Testimonial and other information related to your participation in the program (“Personal Information”) is collected pursuant to sections 26(c), 26(e), and 27(1)(a)(i) of the Freedom of Information and Protection of Privacy Act. This information will be used for administrative, evaluation, program development, and /or research purposes, including to determine your eligibility for participation in the program. This information may also be disclosed to the BC Ministry of Education, the BC Ministry of Social Development and Poverty Reduction, the BC Ministry of Indigenous Relations and Reconciliation and/or the BC Ministry of Jobs, Trade and Technology for administrative, evaluation, program development and/or research purposes, and will be provided to the Government of Canada (“Canada”) to meet reporting requirements about programs funded by Canada through the Canada-British Columbia Workforce Development Agreement. If a Testimonial is provided, the Testimonial may be used and disclosed to publicly promote the program.

Consent and Agreement Effective as of the date set out below, and in consideration of the opportunity for me to participate in the Express to Success program, I:

  • Certify that all of the information that I have provided is accurate and complete;
  • Certify that I understand that my agreement to provide this information and complete the surveys is a condition of participation in the program;
  • Consent to the collection (including indirect collection), disclosure, and use of my Personal Information by the Province of British Columbia and the Government of Canada for the purposes described above;
  • Consent to my Personal Information being used to contact me to conduct the Surveys and to request a Testimonial.

If you have any questions about the collection and use of this information, please contact the Director, Employment and Training Programs, by telephone at 250-508-5671, or by mail at:

Director, Employment and Training Programs
Workforce Innovation and Division Responsible for Skills Training
Ministry of Advanced Education, Skills and Training
PO Box 9189 Stn Prov Govt Victoria BC V8W 9E6

I, the undersigned, hereby accept and agree to the above terms and conditions.