Online Employment & Training Form

Additional Information
How did you hear about this program?
What are your short-term employment/career goals?
What are your long-term employment/career goals?
What types of work are you interested in doing?
Identify any necessary adjustment or accommodations at job location.
E.g. access and/or equipment needs that may be required due to a health issue or disability.
Have you applied for Employment Insurance Benefits in the past 52 weeks?
- Yes
- No
- Unsure
If “Yes”, Where?
Consent*
I give consent to the Ministry to indirectly collect, use and disclose my personal information for the purposes set out below, and confirm that the information contained in this application is true, accurate and complete. This authorization is in lieu of a signature.
W5 is required to:

• make its records available to the Ministry for inspection, investigation or audit
• report on the service it tailors and provides you
• report on your satisfaction with the services you receive

The Ministry will also collect relevant personal information about you from the Government of Canada (Canada) if necessary. The purpose of this information is to determine your eligibility for Employment Insurance benefits, the nature and level of Employment Insurance benefits, and to monitor, assess and evaluate the effectiveness of Employment Service. Depending on the type of service or support you receive and any incentives available to your employer to hire you, your organization or the Ministry may also collect personal information about you from your employer.

If you are a client of, or applying to, the Ontario Disability Support Program or Ontario Works, the Ministry will provide your personal information to the Ministry of Children, Community and Social Services (MCCSS) for the purposes of administering employment services and managing the participation of MCCSS clients in employment support programs under the Ontario Works Act, 1997, and the Ontario Disability Support Program Act, 1997.

Employment Service is funded by the Ministry, in part with funds provided by Canada under Part II of the Employment Insurance Act. When funds are provided by Canada, the Ministry is required to provide information to Canada to help monitor and assess the Employment Insurance Program, as required under s.3 of the Employment Insurance Act. Under the Labour Market Development Agreement between Canada and Ontario (LMDA) and the Workforce Development Agreement between Canada and Ontario (WDA), the Ministry is required to collect your social insurance number.

The Ministry collects your personal information pursuant to the LMDA and WDA, ss. 3 and 63 of the Employment Insurance Act, S.C. 1996, C.23 as amended, and s.76.29 of the Employment Insurance Regulations, SOR/96-332. The Ministry will collect personal information from clients who identify as Ontario Disability Support Program or Ontario Works recipients and disclose your personal information to MCCSS in accordance with the s.71 of the Ontario Works Act, 1997, and s.53 of the Ontario Disability Support Program Act, 1997 the service it tailors and provides you.
CAPTCHA
10+5=*
(After entering the correct answer in the box above, the Submit button will appear.)
Name
This field is for validation purposes and should be left unchanged.

Step 1 of 5

Participant Details

Participant Address and Contact Information

Education Information

Employment/Volunteer Experience

Additional Information

Our services are funded by