Participant Intake Form

Name*

First Name

Last Name

Birthdate*

Canadian Status*

Gender Identity*

Male Female Trans Non-Binary Prefer Not To Say

Other:

Preferred Pronouns

He/Him She/Her They/Them Ze/Zir She/They They/She He/They They/He My Pronouns are Not Listed

What Pronouns do you Prefer?

Address

Address Line 1

Address Line 2

City

Province

Postal Code

Best Phone Number To Reach You*

555-555-5555 x555

Email*

Do you currently have a bank account?*

Yes No

Are you currently on Ontario Works or ODSP?*

Yes No

Do you currently have access to your own transportation?*

Yes No

What is your highest completed level of education?*

Do you currently have stable housing or are you in need of assistance?*

How would you rate your current construction knowledge?*

Do you have any limitations that would affect your ability to work?*

Yes No

Please Explain:

What are some of the barriers to meaningful employment that you have experienced?*

Why do you want to join the Construct Program?*

Did anyone refer you to Construct? If so who?

This is an full-time, 8 week, pre-apprenticeship program. Are you comfortable making this commitment? *

Yes No

I want to sign-up for e-newsletters to receive the latest news and updates about Construct and Blue Door.

Yes No

If Possible, Please Upload your Resume/CV

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