Frog Lake First Nation ISET Agreement 

PARTICIPANT INFORMATION FORM

 

    File Number (Source of Funding)
    Client Identification
    Gender
    Contact Information
     
    Source of Income

    $
    (*On EI Regular Benefits in the last 3 years OR oon special Benefits (Mentality and Parental) in the last 5 years)
    Languages Spoken
    Aboriginal Group
    Marital Status
    Number of Dependant Children



    BARRIERS TO EMPLOYMENT: (CHOOSE ALL THAT APPLY)
    EDUCATION LEVEL
    MOST RECENT WORK EXPERIENCE
    OTHER WORK EXPERIENCE
    PARTICIPANT CONSENT TO RELEASE INFORMATION
    I, the undersigned, give my consent for to Release the information contained in this form regarding my participation in an ASETS program to HRSDC/Service Canada and “Name of Agreement Holder”. I acknowledge that the information is collected and administered in accordance with the Privacy Act and applicable to privacy laws, and that is may be used to determine my eligibility for the ASETS program and provided to HRSDC/Service Canada for the evaluation and accountability of the ASETS/SPF program.