Career Continuity Intake Question Title * 1. Your Contact Information Full Name Address City/Town State/Province ZIP/Postal Code Country Email Address that I check frequently Best Phone Number OK Question Title * 2. Are you a Canadian citizen eligible to Work in Canada? Yes No OK Question Title * 3. Date of Birth OK Question Title * 4. Are you currently employed? Yes, employed full time Part time employment Under-employed - less than 20 hours per week Unemployed (actively seeking to increase employment, notice of imminent lay-off, must leave current occupation due to personal reasons/medical reasons) Returning to school in the Fall - or would like to obtain further training Other (please specify) OK Question Title * 5. Are you currently on EI benefits or have received EI in the past 5 years? Yes No How long ago? Date of claim OK Question Title * 6. Do you have a valid driver's license? Yes No OK Question Title * 7. Education & Training Information University - Program of Study - Name of Program/degree, Year completed, In progress College/Technical - Name of program, Institution, Courses Secondary (Grade 12 graduate) completed - Name of institution, graduating year: Professional Development courses: Certifications, life long learning, etc. Self Study - areas of high interest? OK Question Title * 8. Do you self-identify as a "person with a disability" Yes No Other (please specify) OK Question Title * 9. Do you require assistance to prepare for, secure, maintain and grow employment and self-employment opportunities? Yes No Other (please specify) OK Question Title * 10. What other factors are affecting your current employability? OK DONE