Youth Employment Program

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Program Starts: January 8, 2024

Address: 4460 Beresford St, Burnaby V5H 0B8

First Name (as it appears on SIN card) *

Last Name (as it appears on SIN card) *

Social Insurance Number *

Date of Birth *

YYYY

Address of Residence & Postal Code *

Phone Number *

Email *

Gender *

Male

Female

Other

Prefer not to answer

Member of a Visible Minority *

Yes

Prefer not to answer

Person with Disability *

Yes

Prefer not to answer

Indigenous Group *

Non status

Metis

Inuit

Registered no-reserve

Registered off-reserve

N/A

Residency Status *

Canadian Citizen

Permanent Resident

Protected Person Entitled to work in Canada

Level of Education *

Elementary

Secondary completed

Secondary in-complete

Post-secondary completed

Post-secondary in-complete

University Degree

Major of University Degree and Completion Year

Are you currently working *

Yes

Are you currently participating in another education or training program *

Yes

How did you hear about us? *

Community Organization

Facebook/Instagram

Family/Friend

Internet Search

Other

Consent *

I consent to Burnaby Neighbourhood House sending me information about upcoming programs, events, volunteer opportunities, newsletters, program offerings, and other promotional type offerings. While you are a current Youth Employment Program client, you will receive informational emails necessary for your continuance in our programs.

Required

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