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Central Jobs Registry Application for Employment

Who should complete this application?
Unemployed persons who are at least 16 years of age, residents of Prince Edward Island, eligible to work in Canada and :

• Seeking work in positions funded by the Special Projects Program, or
• Students seeking jobs funded through the Jobs for Youth Program.

Fields marked with a red star (*) are mandatory.

Personal Information
Last Name: *
First Name: *
Initial: *
Address: * Street/Apartment/P O Box
Rural Route:
Community: *
Postal Code: *
Email Address:
Telephone: i.e. 111-555-2222
Telephone Other: i.e. 111-555-2222
Social Insurance Number: * i.e. 555444777
Are You a Resident of PEI?: * Students attending off Island schools respond, "Yes".	Yes No
Gender and Date of Birth These questions asked with the approval of the Human Rights Commission.(For statistical purposes only)
Gender and Date of Birth: * These questions asked with the approval of the Human Rights Commission.(For statistical purposes only)	Female Male
Birthdate:Year: * yyyy
Birthdate:Month: * mm
Birthdate:Day: * dd
Contact in Case of Emergency
Name: *
Address: *
Telephone: * i.e. 111-555-2222
Work Locations What areas of the province are you willing to work?
Work Location 1:
Work Location 2:
Work Location 3:
Voluntary Response Your voluntary response to the following questions will assist us in determining our diversity and equity goals. Information provided in this section is used to identify applicants in designated groups and only for human resources planning and statistical purposes.
Are you:	A person with a disability? An Aboriginal person? A member of a Visible Minority group?
Visible minority, please specify:
Education
Are you enrolled in full time studies?:	Yes No
Will you be returning to school full-time in the current year?: *	Yes No Undecided
If undecided: If you are not returning please state reason?
Highest Grade Completed:: * Enter your last completed grade.
Year Completed: * Enter the year that you completed your highest grade.
Highest Education: * Highest education currently enrolled or completed?	Select One School College University
College: Program: If you selected "College," what is the name of the program?
University: Degree: If you selected "University," what is the name of the degree?	Select One Bachelor Diploma Masters PHD
University: Faculty:
University: Major:
University: Major:
Work Experience Skills, Work Experience, Volunteer Work: All applicants complete this section.
Work Experience:: * Beginning with your most recent employment,list employer,type of work,duration of work.
Resume: You may attach a resume.
Skills
Driver's License:: * Do you have a valid Driver's license?	Yes No
Vehicle:: Type of vehicle, for use in your work?	Car Van Truck Cycle
Typing skills:: * Can you type?	Yes No
Words/Min::
Languages Spoken: *	English French Other
Other Language:
Computer Skills:	Word Processing Data Entry Accounting Internet/email Spreadsheet Networking Programmer
Job Interests The Employment Development Agency is working in cooperation with private sector businesses to create full time work opportunities. If you are interested in meeting with a Workplace Resources Project & Information Officer to discuss employment and labour market information and to receive assistance with your job search :
Please indicate if you would like to be contacted::	Yes, please contact me No, thank-you
Please indicate your work status:	I'm currently, Unemployed Employed full time Employed part time
Preferred type of Work: *	Any Type of Work Only the Following
Preferred Work:
Preferred Work:
Preferred Work:
Declaration In submitting this application, I certify that the information is true in substance and complete to the best of my knowledge. I authorize the Employment Development Agency to verify the above information and to obtain or release confidential information on employment eligibility to be used only for the purpose of providing employment opportunities.

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