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Québec - PEI Summer Student Exchange Program

Who should complete this application?

University students interested in obtaining summer employment in the province of Québec within the Québec Public Service.

Applicants must:

• Be Canadian citizens;
• Be permanent residents of Prince Edward Island;
• Be enrolled full time at a university in the fall 2005 and winter 2006;
• Be a first-time participant in this program;
• Have a satisfactory level of proficiency in French and English.

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

Personal Information
Last Name: *
First Name: *
Permanent Address: *
Community: *
Postal Code: *
Telephone: *
Temporary Address:
Community:
Province:
Postal Code:
Telephone:
Email Address:
Social Insurance Number: * i.e. 555444777
Citizenship: *	Canadian Other Permanent Resident
Gender and Date of Birth These questions asked with the approval of the Human Rights Commission. (For statistical purposes only)
Gender:	Female Male
Birth date: Year: yyyy
Birth Date: Month: mm
Birth Date: Day: dd
Current Studies
Name of Institution Attended: *
Address: *
Year: *	1 2 3 4
Level: *	Certificate/Diploma Bachelor Masters Doctorate
Specialty: *
Returning to School: * Will you be returning to school full-time in the fall?	Yes No
Other University Studies:
Year:	1 2 3 4
Level:	Certificate/Diploma Bachelor Masters Doctorate
Specialty:
Additional Information
First language: * (first language learned and still understood)	French English Other
Other Language:
Languages Spoken: *	French English Other
Other:
Languages Written: *	French English Other
Other:
Travelled: * Have you ever travelled or studied in another province or country? If yes, include details in your resume.	Yes No
Resume: Please attach your resume.
Skills
Driver's License:	Yes No
If Yes, Specify Class:
Vehicle: * Do you have a vehicle available to you for the summer?	Yes No
Computer Skills: (please specify)
Typing Skill: Can you type?	Yes No
Words/Minute:
Certifications
Certified: Are you certified in the following?	First Aid Water Safety CPR Other
Other:
Declaration In submitting this application, I agree that I have read the terms and conditions of the program and certify that the information given is complete and correct. I authorize the Acadian and Francophone Affairs Division to verify the above information and to obtain or release confidential information on employment insurance eligibility to be used only for the purpose of providing employment opportunities.
Notice If you request a copy of the form, it is preferable to print it on legal size paper.

Do you want a copy of the form?

	Please send me a simple text-only version of the information I submitted.
	Please send me an Acrobat version of the form, with the information I've entered above filled in, that I can print and save.
	Please send me both the text-only version and the PDF.
Important Note: Email is not, by its very nature, a secure medium; if you choose to have your form emailed to you, the information you entered will be transmitted over the public Internet to your email box.

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