Your First Name
Your Last Name
Your Phone
Your Email
Date of Birth
Highest Level of Education
Are you a past client of Work Prep?
YesNo
How did you hear about our services?
Social MediaPosterFamily/FriendSaskJobsProbationsSocial ServicesProvincial Jail (RPCC)Virtual Reality - Career Exploration
Other
Referred by:
Optional: Cultural/ethnic background
IndigenousImmigrantOther
What are your challenges to finding employment? (Please check all that apply)
Lack of work experienceHow to search for jobsCriminal RecordDisabilityOnline application/AssessmentChildcareDriver's LicenseTransportationHousingIDAnswering interview questionsResumeCover LetterLack of training or education
Other
Would you consider or would you be comfortable using Virtual Reality to help explore career options?
YesNoUnsure at this time
Thank you for your interest in Work Prep! Please read this consent and sign below.
I authorize the release, disclosure or exchange of information with Regina Work Preparation Centre as required in the developing and delivering of the employment assistance services provided to me. Including the forwarding of relevant information about my participation in their services and programs to any person, agency or government agency as may be necessary to support my service plan, including, but not limited to, the following organizations:
- The Government of Saskatchewan Ministries of Social Services, Immigration and Career Training, Justice and Corrections & Policing;
- The Workers Compensation Board
- The Correctional Service of Canada
- Employers, Educators and Community-based organizations involved in your employment plan
I understand that my counselor can break confidentiality under the following circumstances: 1) as mandated by law, 2) to prevent a clear and immediate danger to a person or persons, and 3) if he/she is compelled to do so by a court or pursuant to the rules of a court.
I agree to email contact from Work Prep regarding the services provided to me and upcoming programs and opportunities
Please write your signature in the box below
