Mi’kmaw Economic Benefits Office

Name*

First Last

Address*

Street Address Address Line 2 City Province Postal Code Country

Email*

Enter Email Confirm Email

Gender:*

Male
Female
Other

Language:

Mi'kmaq
English
French
Other

Band Name / NCNS Zone:*

Band Number:*

Employment Status:*

Employed
Not Employed
Student

Employer Name:

Position/Title:

College/University:

Program Name/Degree:

Program Name/Degree Type:

1 Year Diploma/Certificate
2 Year Diploma/Certificate
3 Year Diploma/Certificate
4 Year Diploma/Certificate

Current Income:*

Employment Insurance
Social Assistance
No Income
Other

Have you received EI in the last three years?*

If you have, what year?

I hereby declare that the statements made by me in the forgoing application are true, correct and complete to the best of my knowledge. I understand that if any information I have provided is found untrue, my changes for employment or training will be severely reduced if not eliminated totally.

I understand that the personal information collected and held by the MEBO program will be used solely to help me access employment services and benefits designed to help me prepare for, secure, and maintain employment.

I hereby grant permission for personal information held by the Mi'kmaw Economic Benefits Office to be disclosed when required to representatives of the Department of Labour and Advanced Education, Centre for Employment Innovation, STAIRS, METS, NCNS, Social Development and to Industry partners for employment/training.

Do you agree?*

Untitled

Program Application

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