EST 3-Week Application Form Name* First Middle Last Date of Birth* DD MM YYYY Gender* Male Female Transgender Do you have a SIN card or know your Social Insurance Number?*YesNoContact InformationPhone*Email* ResidencePlease check the one that best fits your current living situation:*Calgary Drop-In CentreOther homeless shelterSubsidized/Supportive HousingRenting, not subsidizedStaying with friend/familyPlease specify:IncomeIn the previous month, what was your total income?*Less than $1049$1050-$1549$1550-$2049$2050-$2549$2550-$3149$3150-$3799$3800-$4299$4300 or moreHow many people do you help support financially (spouse, children)?:Check off all sources of income you are current receiving:* No source of money Money from family/friends Work, full-time Work, part-time Work, temp agency Canada Pension Plan (CPP) Canada Pension Plan, Disability Social Assistance/Welfare Medical Social Assistance/Welfare Assured Income for the Severely Handicapped (AISH) Employment Insurance (EI) Other In other:EducationWhat is the highest level of education you have completed?*Grade 6 or lessGrade 7 - 9Grade 10 - 12High School DiplomaGEDCollege ProgramUniversity ProgramDid you complete your highest level of education in Canada?*YesNoPersonal InformationDo you have or are you eligible for First Nation or Metis status?*YesNoAre you an immigrant to Canada within the last 10 years?*YesNoHave you completed your Refugee Hearing/Notice Of Decision?*YesNoDo you have a valid Work Permit and Study Permit?*YesNoPlease select your Canadian citizenship status:*Canadian CitizenLanded ImmigrantRefugeePermanent ResidentWork/Student VisaWorkshopsAll of the following workshops are included in the Full Time 3-Week program and you must be prepared to participate in all workshops. Please check off the courses that will help you achieve your employment and personal goals:Beginner Computer Training - 25% of class time Internet & Email Microsoft Word Microsoft Excel Employment Strategies - 25% of class time Career Planning Resume Building Interview Skills Job Search & Apply Life Skills - 25% of class time Constructive Thinking Money Management Self Esteem Finding Balance Stress Management Employee Rights & Benefits Industry Certifications - 25% of class time WHMIS (Norcat) Construction Safety Training System with WHMIS Standard First Aid & CPR Level C Forklift Operation & Safety Transportation of Dangerous Goods (TDG) (Norcat) ProServe Fall Arrest Not offered during the 3 Week Program H2S Alive (ENFORM) Flagger Training (ACSA) Reason for ApplyingHow will taking the 3-Week EST course help you achieve your personal and employment goals?How did you hear about the 3-Week EST program?I declare that I have read and understood the statements in this application and that the statements made on this application are true and correct to the best of my knowledge.*YesSignatureThe personal information collected on this form, during the interview, or any other personal information collected and maintained as part of a student’s record, is collected under the authority of Section 11(b) of the Personal Information Protection Act. This information will be used to determine your eligibility for admission to the Employment Services Training program at the Calgary Drop-In & Rehab Centre, to facilitate your enrollment, to administer and evaluate the Employment Services Training program, and for statistical purposes. Certain information will also be disclosed to Alberta Employment and Immigration to comply with reporting requirements. Your personal information will be protected by the provision of the Personal Information Protection Act and can be reviewed on request. If you have any questions about the collection or use of this information, contact the Privacy Officer of the Calgary Drop-In & Rehab Centre at 1 Dermot Baldwin Way, Calgary, Alberta T2G 0P8 or (403) 266-3600.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.