Participant Information Report – Youth Participant Report – Youth Report To be filled out by all Youth Interns when they are hired. Contact InformationYouth Intern Name First Last Home Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code PhoneEmail Date of Birth* Date Format: YYYY dash MM dash DD LanguagesWhat is your mother tongue? (That is, the language you first learned and still speak)*EnglishFrenchOther (please specify)Language Spoken?*EnglishFrenchBothOther (please specify)Language Written?*EnglishFrenchBothOther (please specify)Language preference?*EnglishFrenchOptional 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: GenderMaleFemaleMember of a visible minorityYesNoPerson with a disabilityYesNoAboriginal GroupRegistered on-reserveRegistered off-reserveNon statusMétisInuitGeneral InformationDo you meet the eligibility criteria?*YesNoResidency Status*Canadian CitizenRefugee under the Immigration and Refugee Protection ActPermanent ResidentOther (please specify)Employment status at start of internship*EmployedUnemployedStudentWill you have any other full-time jobs (more than 30 hours per week) during your internship?*YesNoAre you currently in receipt of Employment Insurance*YesNoEducationHighest level of education completed*Grade 8 or lessGrade 9Grade 10Grade 11Grade 12Year 1 – Post Secondary Education but not university (including CEGEP)Year 2 – Post Secondary Education but not university (including CEGEP)Year 3 – Post Secondary Education but not university (including CEGEP)Year 4 – Post Secondary Education but not university (including CEGEP)Year 1 – University Undergraduate ProgramYear 2 – University Undergraduate ProgramYear 3 – University Undergraduate ProgramYear 4 – University Undergraduate ProgramYear 1 – University Graduate ProgramYear 2 – University Graduate ProgramYear 3 – University Graduate ProgramYear 4 – University Graduate ProgramName 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*YesNoI intend to return to school full time in the upcoming academic year*YesNoI am currently enrolled at a university or other post-secondary institution*YesNoIn my opinion this position is related to my field of study*YesNoConsentAgree 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.