First Name *
Last Name *
Age *
\n15
16
17
18
Postal Code *
\n
K2A
K2B
K2H
K2K
K2W
K2C
K1Z
K0A
K1B
K1G
K1H
K1V
K1T
K1M
K1L
K1K
K1J
K1C
If the first 3 digits of your postal code are not listed, please answer the questions in Section 2.
Phone Number *
Email Address
Do you have Canadian previous paid work experience? *
\nYes
No
Do you have any of these experiences? *
V olunteerB aby SittingC o-op PlacementN one
Do you have a Social Insurance Number? *
\nYes
No
Do you have your own bank account? *
\nYes
No
Are you available to work for 6 consecutive weeks during the Summer of 2010? *
\nYes
No
Have you participated in this program in the past? *
\nYes
No
SECTION 2 - ONLY FILL IN IF POSTAL CODE IS NOT LISTED ABOVE
Section 2 is only filled in if you do not reside in one of the postal codes that are listed above.
Do you have unemployed parents and/or have parents on social assistance?
\n
Yes
No
Have been, or are, in the care of a Children’s Aid Society (CAS)?
\n
Yes
No
Have been, or are, at risk of being in conflict with the law?
\n
Yes
No
Have been, or are, at risk of dropping out of school?
\n
Yes
No
SECTION 3 - EDUCATION INFORMATION
Fill in this section ONLY if you are interested in obtaining 2 co-op credits for high school.
Current Grade *
\nGrade 8
Grade 9
Grade 10
Grade 11
Grade 12
Not in school
# of credits you will have by June 2010
Home School
Security Box *
Y es
Do you agree that all the information provided is all correct to the best of your knowledge?
DO NOT FORGET TO CHECK THIS BOX BEFORE SUBMITTING!
