Personal Information

Please provide your legal name.

First Name*

Last Name*

Middle Name

Preferred Name (if different from above)

Date of Birth*

Gender Identity*

Gender Pronouns

What language(s) other than English do you speak at home?

Has your employment been effected by Tariffs imposed on Canada by the United States Government?*

YesNo

How did you hear about YES Manitoba?*

Were you referred to us by your EIA or Jobs on Market caseworker?*

YesNo

Have you ever been in CFS (Child and Family Services) care?*

Please SelectYes, I was previously under CFS careYes, I am currently under CFS careNo, I have never been under CFS care

Contact Information

Your Address*

Apartment, Unit, Suite #

Street Address*

City*

Province* Please SelectMBNLPENSNBQCONSKABBCYTNTNU

Postal Code*

Delivery Mode:

PO Box or Rural Route #:

Primary Phone Number:*

Alternate Phone Number:

Email:*
Please provide an email that you check regularly.

Alternate Email:

I consent to receiving email notifications of newsletters and upcoming opportunities.*

I consent to receiving text reminders of my appointments.*

Employment & Income Information

Source of Income:*

EmployedSelf-EmployedIncome-AssistanceEINo IncomeOther Income

Have you been looking for work for 6 months or more?*
YesNo

Education Information

What is the highest level of education you have completed?*

Where did you complete that education?*

What year did you complete that education?*

Additional Information

Do you self declare as a person of Indigenous Ancestry?

YesNoPrefer not to say

What is your marital status?*

SingleMarried or EquivalentPrefer not to say

Do you have dependents?*

YesNoPrefer not to say

Do you self-declare as living with a disability?* (Physical, cognitive, neurodevelopmental, psychological, chronic etc.)

YesNoPrefer not to say

Do you identify as a member of a racial or ethnic minority group?*

YesNoPrefer not to say

What is your residency status?*

Please SelectCanadian CitizenPermanent ResidentImmigrant/Refugee

Privacy and Consent Form

As part of our funding agreement we require the following Privacy Notice and Consent Form for Training and Employment Services to be signed. Please note that Youth Employment Services is compliant with all FIPPA legislation.

I agree to the collection and use of my information as stated in the Privacy Notice and Consent Form

Client Signature:*

Date of Application:*