Name(Required) First Last Email(Required) Phone(Required)Date of Birth(Required) Month Day Year Are you a Canadian citizen or Permanent Resident?(Required) Yes No If no, what is your current immigration status in Canada?City you live in(Required)What is your employment/career or education goal?How can we best support you in reaching that goal? (select all that apply)(Required) Career direction Self-employment Job search Resume writing/interview skills Training/going back to school Apprenticeship Other OtherWhat is stopping you from reaching your employment or education goal? (select all that apply)(Required) Lack of skills/training Lack of education Lack of experience Job search skills (don’t have resume; help with interviews, etc.) Lack of transportation Don’t know what kind of job I want/would be good at Lack of funds/resources/stable housing Don’t know who is hiring Literacy Criminal record Child Care Illness OtherDo you have a driver's license?(Required) Yes No If so, what class license?G1G2GWhat is your primary mode of transportation?(Required) Car Bus Walk Other Are you currently working?(Required) Yes No If yes, how many hours per week?Additional Comments