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INDIGENOUS SKILLS & EMPLOYMENT TRAINING PROGRAM

YTDF FIRST NATIONS

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YTDF ISETP Application Form

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Client Identification

Who is your employment counselor?*

Last Name*

First Name*

Middle Name(s)/Initials*

Maiden Name (if applicable)

Gender*

Male
Female
Unspecified

Contact Information

Apartment/Unit # (if applicable)

Street Address or Box #*

City/Town/Community*

Province*

Postal Code*

Phone Number (inc. area code)*

Other Number for Messages

Email Address*

Source of Income

EI Claimant*

Employment Insurance Active Claimant
Reach-Back Client/Former Client(no longer receiving regular benefits in the last 3 years or on special benefits (maternity, parental, sickness, etc) in the last 5 years)
Non-Insured Client
Other (specify)

Social Assistance Recipient
(Provincial or First Nation)*

No Yes

Languages Spoken*

English Only
French Only
English & French
Aboriginal Language(s) Only
Aboriginal Language(s) & English
Aboriginal Language(s) & French
Aboriginal Language(s), English
& French
None of the Above (Please Specify)

Marital Status*

Married or Equivalent
Single
Divorced
Widowed
Separated

Education Level (HIGHEST Level Attained)*

No Formal Education
Secondary School Diploma or GED
University Certificate or Diploma
Up to Grade 7-8
(Secondary I = Grade 8)
Some Post-Secondary Training
University - Bachelors Degree
Grade 9-10 (Secondary II-III)
Apprenticeship or Trades Certificate or Diploma
University - Masters Degree
Grade 11-12 (Secondary IV-V)
College, CEGEP, or other Non-University Certificate or Diploma
University - Doctorate

Province/Territory in which highest level of education was attained:*

Aboriginal Group*

Registered (Status) Indian

Treaty #

Band Name

Band Province

Non-Status Indian
Métis
Inuit

Disability*

No
Yes (Specify)

Training

Training Course

Expiry

Standard First Aid

Expiry

Emergency First Aid

Expiry

CPR

Expiry

H2S Alive

Expiry

WHMIS

Expiry

Chainsaw

Expiry

PST/CST

Expiry

TDG

Expiry

Confined Space

Expiry

Fall Protection

Expiry

Overhead Crane & Rigging

Expiry

Other

Expiry

Most Recent Work Experience

Name of Current/Former Employer

Employer Address

Job Title

Dates of Employment (from/to)

Name of Supervisor

Contact Number

Reason for Leaving

Other Work Experience

Former Employer

Job Title

Reason For Leaving

Former Employer

Job Title

Reason For Leaving

Former Employer

Job Title

Reason For Leaving

Career/Training Interest for Employment

Employment Goal*

Plan to Succeed*

How long ago did you decide to work in this field?*

Why do you think this occupation is suitable/appropriate for you? (Why did you choose this occupation?)*

What special qualities/strengths/talents do you possess that make you suitable for this kind of work?*

Is there a reasonable chance for employment upon completion?*

Barriers to Employment (choose all that apply)
What are some complications preventing you from finding employment?

None
Lack of Labour Force Attachment
Lack of Work Experience
Lack of Transportation
Remoteness
Language
Education
Economic
Dependant Care
Lack of Marketable Skills
Other Barrier Not Listed Above (specify)

Do you have any health problems that would interfere with employment?

Addictions
Physical
Mental Health

If so, please explain:

Number of Dependant Children

Dependant Children*

Yes
No

Number of Dependant Children*
Under 18 Years Old

Childcare Need*
is childcare required for this intervention

Yes
No

Childcare Funded (choose type of support, if applicable)

Not Applicable
FNICCI
EI/CRF
Provincial Funding or Subsidy
No Funding Recieved
Daycare Space Not Available
Assisted by Family/Self-Funded

Funding Application

Training (Intervention)*

Name of Employer*

Confirmation Letter*

No Yes
Intervention Type (choose all that apply).
For definitions please see Interventions Defined for the Indigenous Skills & Employment Training Program (ISETP)*
You must choose at least one

The definiton of an intervention: An action plan activity, within a specific timeframe, developed by a client and a case-manager/counsellor intended to assist a client to improve employability in order to prepare for, obtain, and/or maintain employment.

Career Research and Exploration
Diagnostic Assessment
Employment Counselling
Occupational Skills Training
(Apprenticeship)
Occupational Skills Training
(Certificate)
Occupational Skills Training
(Degree)
Occupational Skills Training
(Diploma)
Occupational Skills Training
(Industry Recognized)
Self-Employment
Employer Referral
Referral to Agencies
Skills Development
(Academic Upgrading)
Skills Development
(Essential Skills)
Work Experience
(Job Creation Partnerships)
Work Experience
(Student Employment)
Work Experience
(Wage Subsidy)
Job Search Preparation Strategies
Job Starts Supports
Employment Retention Supports

Training Provider*

Intervention Start Date*

Intervention End Date*

Intervention Duration (days)*

Intervention Cost (total budgeted costs of the intervention)*

Comments

Please Note: This short application will be emailed directly to your ISETP data clerk for confirmation and verification of the information presented. You will be contacted by email to set up an interview date with the case manager and informed of any further documentation you will need to bring with you.

Participant Consent to Release Information

I, the undersigned, give my consent for YTDF-ISETP and/or Sub-Agreement Holder to gather and release the mandatory information contained in this form regarding my ISETP participation/application to ESDC/Service Canada. I acknowledge that the information is collected and administered in accordance with the Privacy Act and the First Nation’s Privacy Policies applicable to privacy laws, and that it will be used to determine my eligibility for the ISETP program funding and services. Further to this I consent to my information herein to be used for the purpose of ISETP program evaluation, accountability, planning and reporting for the YTDF organization and its sub-agreement community governments. I also consent to my information to be added to the YTDF - ISETP Skill Inventory Bank for program marketing and/or employment purposes.

Name*

Date*