Participant Information Report – Youth

Contact Information

Youth Intern Name

First Last

Home Address*

Street Address Address Line 2 City Province Postal Code

Phone

Email

Date of Birth*

Languages

What is your mother tongue? (That is, the language you first learned and still speak)*

English
French
Other (please specify)

Language Spoken?*

English
French
Both
Other (please specify)

Language Written?*

English
French
Both
Other (please specify)

Language preference?*

English
French

Optional

The Federal Government is committed to equity in employment. You are encouraged to complete the following section and indicate if you are a member of any of these groups:

Gender

Male
Female

Member of a visible minority

Yes
No

Person with a disability

Yes
No

Aboriginal Group

General Information

Do you meet the eligibility criteria?*

Yes
No

Residency Status*

Canadian Citizen
Refugee under the Immigration and Refugee Protection Act
Permanent Resident
Other (please specify)

Employment status at start of internship*

Employed
Unemployed
Student

Will you have any other full-time jobs (more than 30 hours per week) during your internship?*

Yes
No

Are you currently in receipt of Employment Insurance*

Yes
No

Education

Highest level of education completed*

Name of educational institution last attended*

In which area(s) were your studies concentrated?*

High school (no specialization)
Engineering
Computer-related
Business-related
Natural Sciences
Arts
Social Sciences & Humanities
Other (please specify)

I was a full-time student during the preceding year*

Yes
No

I intend to return to school full time in the upcoming academic year*

Yes
No

I am currently enrolled at a university or other post-secondary institution*

Yes
No

In my opinion this position is related to my field of study*

Yes
No

Consent

Agree

Yes

I give my consent for the Ontario Library Association to release the information contained in this form regarding my participation in a YES program to Innovation, Science and Economic Development Canada and HRSDC. I acknowledge that the information is collected and administered in accordance with the Privacy Act and applicable privacy laws, and that it may be used to determine my eligibility for the YES and provided to Innovation, Science and Economic Development Canada and HRSDC for the evaluation and accountability of the YES program.

Participant Report – Youth Report

Contact Information

Languages

Optional

General Information

Education

Consent