Essential Skills Upgrading Application Form For questions about this form or if you require an alternate format, please contact Essential Skills Upgrading at firstname.lastname@example.org. Name* First Middle Last Email* Telephone Number*Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Date of birth*Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031Age*Please provide a rationale of why you are choosing to pursue Essential Skills Upgrading through Durham College rather than your school board?*Please select your current status in Canada* 10 - Canadian Citizen 20 - Aboriginal 30 - Permanent Resident 70 - Refugee 80 - Convention Refugee Do you have a valid Social Insurance Number?* Yes No What is your current employment status?* Employed Full Time Employed Part Time Unemployed Are you a student currently enrolled in a post-secondary program?* Yes No Are you ready and able to attend a workshop for two full weeks during 10 am – 2 pm?* Yes No To ensure your speaking & listening skills are sufficient to benefit fully from the language of LBS instruction (English), please ensure that you are comfortable with the following:* Making an appointment over the phoneSharing your opinion at a small informal meeting, such as giving advice to a friendFollowing some safety steps outlined in a workplace training videoUnderstanding a teacher’s advice on how to improve your English Yes No Which Workshop would you like to start first? Food Service Industry Workshop Retail Industry Workshop Warehousing Industry Workshop What are your employment goals? What industry are you looking to gain employment in?*Please select the goal path that best aligns with why you are taking our Essential Skills workshop:* Employment Post-Secondary Independence Apprenticeship Students may require support for a variety of reasons while they attend Essential Skills programming, for instance, if you had an IEP in high school, or you have a diagnosed learning disability. Please select "yes" to this question if you think you will require accommodations or support for your intake assessments that are required to enroll in Essential Skills courses.* Yes No Are you currently receiving employment supports from an Employment Ontario (EO) service provider (for example Job Search Support, Interview Prep or Resume Help)* Yes No How did you hear about these workshops? In accordance with Section 39(2) of the Freedom of Information and Protection of Privacy Act, 1990, the personal information collected on this form is collected under the legal authority of the Ontario Colleges of Applied Arts and Technology Act, 2002 and may be used and/or disclosed for determining eligibility for entry into the Essential Skills Upgrading program. Your personal information may also be used for various administrative, statistical and/or research purposes of the College and/or ministries and agencies of the Government of Ontario and the Government of Canada. If you have any questions about the collection, use and disclosure of your personal information by the College, please contact the Freedom of Information and Protection of Privacy Coordinator, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, 905.721.2000 ext. 3292.