| Proposed Candidate: |
| Candidate Name: |
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Social Insurance Number: |
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| Mailing Address: |
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Postal Code: |
| Telephone: |
Fax : |
| How did you recruit and select this person? |
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| Will you be hiring or training any other staff? |
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| JOB OPPORTUNITY |
| Job Title: |
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Employment Start Date: |
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| Total Hours per week: |
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Between the hours of (am/pm) and (am/pm) |
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| Rate of Pay for this position is: $/hour |
Number of Weeks to Train this position is: |
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| Is it your intention to provide ongoing employment to the participant after the subsidized training period? |
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| Comments: |
| In the space provided below, describe in detail the following Activities/Duties to be introduced during the training period and include the approximate duration (attach additional sheet if necessary). |