EmailMe Form - Into the World of Work

Name

First Last

Date of Birth *

MM / DD / YYYY

Phone number *

### - ### - ####

Email *

Are you a Permanent Resident in Canada or Convention Refugee *

Yes

No

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Consent Statement *

	Yes	No
CICS staff sending me E-mail with services and program information. I understand that I can withdraw my consent at any time.
CICS has the right to obtain media recording including but not limited to photographs and videos of me for promotional uses by CICS through its media outlets.

I would like to pre-register for (please select all that apply):

Module 1- Job readiness skills

Module 2- Communication in the workplace

Module 3- Canadian Workplace culture

Module 4- Your rights in the workplace

Module 5- Social effectiveness skills