01 ISR - Application Form

Webinars

Please correct the errors described below.
Include first and last name

CONSENT TO DISCLOSURE: Thank-you for applying to our Career Coaching Workshops funded by the Alberta Government. Because the costs for these workshop(s) are covered by the Alberta Government, we need to provide them with basic information on who our participants are, and this information is entered into their database (mobius). By participating in these workshops, you are agreeing to us sharing some basic information with our funder for the purposes of program management and project monitoring. Additionally, if you have been requested to participate in these workshops by Alberta Community and Social Services, you are agreeing to us advising them if you do attend the workshops. Declaration/Consent The personal information provided to R. Work Group is collected, used, and disclosed under the authority of sections 33 to 40 of the Freedom of Information and Protection of Privacy Act. If you have questions about the collection or use of your personal information, please contact Bonnie Maguffee, R. Work Group director at 780-814-4172. By dating this form below and returning it you are acknowledging that you have read and understand this consent to disclose.

Webinars

Background Information

Are you an immigrant to Canada?
If you are an immigrant, what year did you emigrate?
Number of people in your household under 18 who depend on you for support

ADDITIONAL CONTACT: It can be helpful if you provide a contact name and phone number of an individual that we can contact if, for some reason, we were unable to contact you (e.g., your phone is disconnected/no minutes). By providing a name and number of an additional contact person, you are agreeing that we can identify who we are and our services, and leave our contact information request. If you do not wish to do this, then leave the Additional Contact Name and Number blank.

Online Informed Consent and Disclosure

1. A detailed overview of your consent is provided as a separate document as part of this email (see attached form), by signing this consent you agree you have reviewed the detailed overview. 2. Online vocational rehabilitation and career coaching services has both benefits and risks, which you and RWG will be monitoring as you proceed with your work 3. You will need to participate in creating an appropriate space for your online vocational rehabilitation and career coaching services sessions. 4. RWG follows security best practices and legal standards in order to protect your health care information, but you will also need to participate in maintaining your own security and privacy

OUR COMMUNICATION PLAN The best way to contact RWG between sessions is by calling 780-539-1072, Monday to Friday, 10 am to Noon, and 1 pm to 4 pm. RWG will respond to your messages within 24 business hours. Please note that RWG may not respond at all on weekends or holidays. If, due to technology, an online session is interrupted, then RWG will contact you by your cell phone or email to confirm booking of the next session

RECORDINGS By signing this form, you are agreeing to NOT record video or audio sessions. Making recordings can quickly and easily compromise your privacy, and we request that this not be done. R. Work Group WILL NOT record video or audio sessions. I understand and agree to the risks and benefits of online delivery of services by R. Work Group. By inserting the date below and submitting this form, you are acknowledging your agreement to abide by our 'recordings' policy.

Thank-you for applying. A Career Coach with R. Work Group will follow-up within 2 business days. Please call 780-539-1072 if you have any questions.

Your information will be encrypted.