Registration Form

PERSONAL INFORMATION:

Social Insurance Number: (We will contact you for further information)

Title: Mr.Mrs.MsMissDr.

Last Name:

First Name:

Middle Initial:

Gender:
FemaleMaleOther

Date of Birth:

Age:

Marital Status: SingleMarriedSeparatedDivorcedWidowedCommon-law

Spouse Name:

Is Spouse Employed:
YesNoFTPT

How many dependent children do you have residing with you?

Age of Children:

INDIGENOUS IDENTIFICATION:

First Nation Group: Treaty Status (registered)Non-StatusInuitMétisNon-Indigenous

Treaty Status #: (We will contact you for further information)

Band Name:

Treaty Location: Treaty 6Treaty 7Treaty 8Out of province

Citizenship:
CanadianOther

Are you entitled to work in Canada?:
YesNo

Language:
EnglishFrenchOther

ADDRESS INFORMATION:

Current Address

City

Province

Postal Code

How long have you been residing at the current address?

Do you live on a Reserve?
NoYes

If yes, which reserve and province?

CONTACT INFORMATION

Home Phone:

Cell Phone:

Messages:

Emergency #:

Email Address

DRIVER’S LICENSE INFORMATION:

Class 1 (any vehicle)Class 2 (Bus)Class 3 (3-axle plus)Class 4 (Taxi/Ambulance)Class 5 (2 axle, car, RV)Class 6 (motorcycle)Class 7 (Learners)Q-Air EndorsedSuspensionNo Driver’s License

Province

Expiry Date:

Do you have a reliable vehicle for work? YesNo

Do rely on public transit system for work? YesNo

REFERRED BY:

Self-ReferredBand OfficeSchool/Post SecondaryCommunity AgencyMétis OfficeFamily/FriendAdvertisementAboriginal OrganizationEmployerAlberta Works Income Support

INCOME INDENTIFICATION:

No IncomeEmployedAlberta Works Income SupportStudent: Loan / GrantSelf EmployedWCBMedical Income SupportBand Education FundingChild Tax CreditAISHBand Social Assistance

Are you Unemployed and Eligible for Employment Insurance? (EI) YesNoDon’t know

Are you Unemployed and currently receiving Employment Insurance? (EI) YesNo

Are you receiving Medical or Maternity Employment Insurance? Medical EIMaternity EINo

Have you received (EI) in the last 3 years? YesNo

Have you received (EI) maternity or parental benefits within the last 5 years? YesNo

CRIMINAL RECORD IDENTIFICATION:

Do you have a Criminal Record?
YesNo

If answer is yes, have you received a pardon?
YesNo

Does this criminal record affect your ability to secure employment? YesNo

DISABILITY IDENTIFICATION:

Have you ever been diagnosed with a disability?
YesNo

What is the nature of the disability?

Do any of your dependents have a disability?
YesNo

What is the nature of the disability?

Does the disability affect employment?
YesNo

EDUCATION INFORMATION:

Did you complete High School?
YesNo

Highest Level Completed K-12

Name of High School

City, Province

Year / Month

Certificate Program Name

Name of College or Training School

City, Province

Year / Month

Name of Post-Secondary Program

Please select program type:

Name of Post Secondary Facility

City, Province

Year / Month

TRADE INFORMATION:

Trade:

Level:

Name of Trade School

City, Province Registered

Date Registered

SAFETY TRAINING:

CSTSConfined SpaceFirst AidPro ServeFirefighterGround DisturbanceWHMISATV RiderCPRASIPOverhead CraneEmergency Fire DispatchTDGFlaggingEMRFood SafetyBOP (PITS)Fall ProtectionH2S AliveForkliftEMTSuper HostChainsaw

List Other Tickets:

EMPLOYMENT INFORMATION: (Please list the last 3 jobs you worked at.)

If you have no work history please specify “none” under the first Company Name

Will you be attending CFT7's Post-Secondary Summer Student Symposium on February 20 & 21, 2025? YesNo

Company Name:

Job Title:

Start Date:

Hourly Rate:

Monthly Salary:

End Date:

Reason for Leaving:

Company Name:

Job Title:

Start Date:

Hourly Rate:

Monthly Salary:

End Date:

Reason for Leaving:

Company Name:

Job Title:

Start Date:

Hourly Rate:

Monthly Salary:

End Date:

Reason for Leaving:

EMPLOYMENT SOUGHT

Full-timePart-TimeTemporaryPermanentSelf-EmployedSeasonalContract

What type of work are you looking for?

What is your career goal or training need?

Do you have appropriate tools and safety equipment required for the work you are seeking? YesNo

Are you willing to relocate for work purposes?
YesNo

Where?

CLIENT CONSENT TO DISCLOSE INFORMATION & SIGNATURE

Information that is collected from you is done so under the authority of the Service Canada - The Indigenous Skills and Employment Training (ISET) Program and the Government of Alberta - Ministry of Community & Social Services (CSS); and/or its representatives and is in accordance and governed by the Protection of Personal Information Act (PIPA) and Freedom of Information and Protection of Privacy Act (FOIP).

I, , understand and consent to the disclosure and exchange of information between Aboriginal Futures Career & Training Centre (AFC&TC) and/or its representatives: Community Futures Treaty Seven-Labour Market Development Program (CFT7-LMDP), Service Canada (ISET) , Ministry of Community & Social Services (CSS) or Human Resources & Social Development Canada (HRSDC), about the status and benefits of Employment Insurance, Income Support, Employment, Training Documents and personal information.

I also authorize the disclosure and exchange of information between AFC&TC and any service providers or individuals that are involved in assisting me to complete my client action plan to verify that the information that I have provided to the AFC&TC is true and accurate. Should I become a participant in a training program, I consent to the disclosure of my personal information to AFC&TC for statistical analysis to be shared with its representatives, and to record this information into the CFT7 Data Centre for statistical purposes as required; by Service Canada (ISET), and into the Mobius Database for the Government of Alberta (CSS).

In the event that I require funding for a skills enhancement intervention, this completed registration form will be part of the application process, as required by Community Futures Treaty Seven-Labour Market Development Programs and/or contracted agents for project-based training programs and individual funding requests.

Your Initial

Today’s Date: