THIS WAY ONWARD REFERRAL FORM

At PCRS, we want to support and work with you. Whether you are looking for a new job, a new home, or an education, our staff are here to help.

We provide employment services to job seekers and employers in various communities to help participants prepare for employment, secure and maintain jobs, and gain meaningful work experience. Employment is a key component to quality of life. We believe that every person has the capacity and potential to be successful given the right support.

To apply for the This Way Onward program, continue to the next page. The following application will ask for some basic information. After you submit this form, you can expect someone from our team to reach out to you with next steps.

Form Type

Program Code

Participant Information

Preferred Name

First Name

Last Name

Legal Name

First Name

Middle Name

Last Name

Basic Information

Date of Birth

Pronoun(s)

Social Insurance Number

Gender

Ethnicity

Contact Information

Primary Phone Number

Alternate Phone Number

Email Address

Preferred Method of Contact

Home Address

Street 1

Street 2

City

Province

Postal Code

Emergency Contact

Emergency Contact Name

Emergency Contact Relationship:

Emergency Contact Number

Emergency Contact Email

Education

Name Of School

Level Completed

Special Needs

Any Special Needs/Preferences That We Should Know About?

Any Health Issues/Conditions/Allergies, Past Or Present That We Should BE Aware Of?

Are There Any Diagnosed Learning Disabilities?

YESNoNot Sure

If yes, please specify

Previous Employment/Volunteer Experience

Are you legally Entitled to Work in Canada?

YESNO

Name Of Last Employer

Start Date

End Date

Reason For Leaving

Location and Availability

Location: Check all that apply

Note: To select multiple options from the picklist, please hold the 'ctrl' /'command' key before selecting your option

Availability: Check all that apply

Note: You will not work for all the days and times mentioned in this section

Are you available for a minimum of 28 hours/week?

Please enter the ideal number of hours you would like to work each week

Eligibility

Are you Unemployed?

Are You between 16-24 years of age?

Are You a Resident of British Columbia

Access to a Computer

Participating in Another Program

Are You a Student

Do You Have Access to Reliable Internet

Level of English Proficiency

Additional Information

How Did You Hear About The Program?