Glow Pre-Employment Program - Referral/Application Form

The Glow Pre-Employment Program is a youth employment service that supports Vancouver at-risk youth to achieve employment.

Eligibility Requirements:

Youth looking for pre-employment support
16-24 years old
Interested in looking for work or starting their career
Interested in getting life skills and and employability skills for pre-employment

Form Type

Program Code

Participant Information

Preferred Name

First Name

Last Name

Legal Name

First Name

Middle Name

Last Name

Contact Information

Primary Phone Number

Alternate Phone Number

Email Address

Preferred Method of Contact

PhoneTextEmail

Home Address

Street 1

Street 2

City

Province

Postal Code

Alternate Address

Street 1

Street 2

City

Province

Postal Code

Basic Information

Date of Birth

Pronoun(s)

Social Insurance Number

Gender

Ethnicity

What language do you need support with?

Emergency Contact

Emergency Contact Name

Emergency Contact Relationship:

Emergency Contact Number

Emergency Contact Email

Program Questions

Are you currently in school?

Have you had previous employment or volunteer experience?

Do you need help getting a government issued ID?

Do you need help opening a bank account?

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

Additional Information

How Did You Hear About the VYS Pre-Employment Program?