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Intake & Needs Assessment Form

Please attach a resume and cover letter if you have one.

All questions marked with an asterisk(*) are mandatory.

* CNA Participating Bands (Please select Band you are registered with)

* First Name:

* Last Name:

* Band Status Number:

* Date of Birth:

Open the calendar popup.

* Address (Include City and Postal Code):

* Phone:

Alternate Phone

* Email:

* Are you: Currently Employed
Currently Unemployed
Seasonally Employed

* Are you: Actively on EI Benefits
Been on EI Benefits in the past five years
Social Assistance
Not Applicable

* Are you currently looking for work: Yes, Full time
Yes, Part time
Yes, no preference
No

What type of work are you looking for:

Do you want full-time or part-time work: Full-time
Part-time
No preference

Are you willing to relocate for employment: Yes
No

Do you have a resume: Yes, it needs updating
Yes, it is current and I am happy with it
No, I need support to create a resume

Do you need support to update or create a new resume: Yes, create a new resume
Yes, update my resume
No, it is up to date and I am happy with it

Upload a copy of your current resume, if you have one: Clear

Do you have a cover letter: Yes, it needs updating
Yes, it is current and I am happy with it
No, I need support to create a cover letter

Do you need support to update or create a new cover letter: Yes, create a new cover letter
Yes, update cover letter
No, I have a cover letter and am happy with it

Upload a copy of your current cover letter, if you have one: Clear

* Are you participating in other programs: (Please check all that apply. Hold down shift key for multiple sections) Adult Upgrading
ASETS, SASET or ISET-P
Work BC
Band
Other
Not applicable

* Are you interested in participating in other programs: (Please check all that apply. Hold down shift key for multiple sections) Adult Upgrading
ASETS, SASET or ISET-P
Work BC
Band
Other
Not interested

Do you have a disability that may limit your participation for employment or training: Yes
No

Do you require any employment accommodations: Yes
No

* Education & Training: (Please check all that apply. Hold down shift key for multiple sections) Less than Grade 12
High School Diploma
GED or Equivalent
Some Post-Secondary
Apprenticeship/Trade Certification
College Certificate or Diploma
University

Please list education and training completed:

* Have you previously taken training with the CNA: Yes
No

If yes, what training did you take:

* Do you have a driver's licence: Yes
No

Driver's licence class & expiry date:

If you do not have a driver's licence, are you able to get one: Yes
No

Other Certifications:

Job Search Challenges: (Please check all that apply) Transportation
Child Care
Disability
Lack of work experience
Lack of education or training
Lack of workplace certifications
No resume or cover letter
Unsure of what type of job I want

Job Search What's Working: (Please check all that apply) Transportation
Child Care
Resume and cover letter
Have work experience
Have Grade 12
Have education and training
Have workplace certification
Know what type of job I want
Willing and able to work

Do you require assistance with childcare/subsidy?

Intake & Needs Assessment Form

Please attach a resume and cover letter if you have one.

All questions marked with an asterisk(*) are mandatory.

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