app.smartsheet.com
Open in
urlscan Pro
3.232.185.209
Public Scan
URL:
https://app.smartsheet.com/b/form/90a0ead7213944bc9983f73a3178b4b9
Submission: On February 29 via api from CZ — Scanned from DE
Submission: On February 29 via api from CZ — Scanned from DE
Form analysis 1 forms found in the DOM
<form>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_undefined" data-client-type="heading" class="css-1e2fy0l e1vg1njp0">
<div class="css-336d07 e13qqj0j0"></div>
<p data-client-id="subheading_undefined" class="css-1ey0zoe e1vg1njp2"></p>
<p>This information is administered with the Privacy Act (R.S.C., 1985, c. P-21) and the Department of Employment and Social Development Canada Act (S.C. 2005, c. 34) and you have a right under the Access to Information Act (R.S.C., 1985, c.
A-1) to obtain access to this information from Canada.</p>
<p><br></p>
<p><br></p>
<p>Cette information est gérée en vertu de la Loi sur la protection des renseignements personnels (L.R.C. (1985), ch. P-21) et de la Loi sur le ministère de l’Emploi et du Développement social (L.C. 2005, ch. 34) et vous avez le droit, en vertu
de la Loi sur l’accès à l’information (L.R.C. (1985), ch. A-1), d’obtenir cette information du Canada.</p>
<p></p>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Company name / Nom de l’entreprise" data-client-type="text" id="AOXnOjK" class="css-1e3khfm ef83ajd0"><label for="text_box_Company name / Nom de l’entreprise"
data-client-id="label_Company name / Nom de l’entreprise" class="css-1xl1v40 ekxsfat0">Company name / Nom de l’entreprise<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div id="description_Company_name___Nom_de_l_entreprise" class="rich-text-field-desc">
<p>This is the company that submitted your details for the subsidy program</p>
<p><br></p>
<p>C’est l’entreprise qui a soumis vos informations pour le programme de subvention</p>
</div>
<div style="display: flex;"><input title="" aria-invalid="false" aria-describedby="description_Company_name___Nom_de_l_entreprise" tabindex="0" id="text_box_Company name / Nom de l’entreprise"
data-client-id="text_box_Company name / Nom de l’entreprise" data-client-type="" name="AOXnOjK" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_First Name (as it appears on SIN card) / Prénom (tel qu’il apparaît sur la carte NAS)" data-client-type="text" id="YYb3emO" class="css-1e3khfm ef83ajd0"><label
for="text_box_First Name (as it appears on SIN card) / Prénom (tel qu’il apparaît sur la carte NAS)" data-client-id="label_First Name (as it appears on SIN card) / Prénom (tel qu’il apparaît sur la carte NAS)"
class="css-1xl1v40 ekxsfat0">First Name (as it appears on SIN card) / Prénom (tel qu’il apparaît sur la carte NAS)<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_First Name (as it appears on SIN card) / Prénom (tel qu’il apparaît sur la carte NAS)"
data-client-id="text_box_First Name (as it appears on SIN card) / Prénom (tel qu’il apparaît sur la carte NAS)" data-client-type="" name="YYb3emO" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Last Name (as it appears on SIN card) / Nom de famille (tel qu’il apparaît sur la carte NAS)" data-client-type="text" id="w5nKOl9" class="css-1e3khfm ef83ajd0"><label
for="text_box_Last Name (as it appears on SIN card) / Nom de famille (tel qu’il apparaît sur la carte NAS)" data-client-id="label_Last Name (as it appears on SIN card) / Nom de famille (tel qu’il apparaît sur la carte NAS)"
class="css-1xl1v40 ekxsfat0">Last Name (as it appears on SIN card) / Nom de famille (tel qu’il apparaît sur la carte NAS)<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Last Name (as it appears on SIN card) / Nom de famille (tel qu’il apparaît sur la carte NAS)"
data-client-id="text_box_Last Name (as it appears on SIN card) / Nom de famille (tel qu’il apparaît sur la carte NAS)" data-client-type="" name="w5nKOl9" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Social Insurance Number / Numéro d’assurance sociale" data-client-type="text" id="zpn0MOl" class="css-1e3khfm ef83ajd0"><label for="text_box_Social Insurance Number / Numéro d’assurance sociale"
data-client-id="label_Social Insurance Number / Numéro d’assurance sociale" class="css-1xl1v40 ekxsfat0">Social Insurance Number / Numéro d’assurance sociale<span data-client-id="required_indicator"
class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex; width: 193px;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Social Insurance Number / Numéro d’assurance sociale" data-client-id="text_box_Social Insurance Number / Numéro d’assurance sociale"
data-client-type="NUMERIC" type="number" name="zpn0MOl" maxlength="4000" class="css-1p0590h e1407lhe0" value="" style="width: 300px;"></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Email/Courriel" data-client-type="text" id="pRnYvdq" class="css-1e3khfm ef83ajd0"><label for="text_box_Email/Courriel" data-client-id="label_Email/Courriel" class="css-1xl1v40 ekxsfat0">Email/Courriel<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div id="description_Email_Courriel" class="rich-text-field-desc">
<p>Personal email address / Adresse courriel personnelle</p>
</div>
<div style="display: flex;"><input title="" aria-invalid="false" aria-describedby="description_Email_Courriel" tabindex="0" id="text_box_Email/Courriel" data-client-id="text_box_Email/Courriel" data-client-type="" name="pRnYvdq"
maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Phone number / Numéro de téléphone" data-client-type="text" id="QpXA2ww" class="css-1e3khfm ef83ajd0"><label for="text_box_Phone number / Numéro de téléphone"
data-client-id="label_Phone number / Numéro de téléphone" class="css-1xl1v40 ekxsfat0">Phone number / Numéro de téléphone<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div id="description_Phone_number___Num_ro_de_t_l_phone" class="rich-text-field-desc">
<p>Personal phone number / Numéro de téléphone personnel</p>
</div>
<div style="display: flex;">
<div class=" react-tel-input" style="height: 35px; width: 40px;">
<div class="special-label">Phone</div><input class=" form-control" placeholder="1 (702) 123-4567" type="tel" name="QpXA2ww" aria-hidden="true" aria-label="phone picker" value="+1" style="display: none;">
<div class=" flag-dropdown">
<div class="selected-flag" title="United States: + 1" tabindex="0" role="button" aria-haspopup="listbox">
<div class="flag us">
<div class="arrow"></div>
</div>
</div>
</div>
</div><input aria-invalid="false" aria-describedby="description_Phone_number___Num_ro_de_t_l_phone" tabindex="0" id="text_box_Phone number / Numéro de téléphone" data-client-id="text_box_Phone number / Numéro de téléphone"
data-client-type="PHONE" type="text" value="+1 (___) ___-____" inputmode="numeric">
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Date of Birth / Date de naissance" data-client-type="date" id="2zLa8Qk" class="css-gbq6lm ef83ajd0"><label for="date_Date of Birth / Date de naissance" data-client-id="label_Date of Birth / Date de naissance"
class="css-1xl1v40 ekxsfat0">Date of Birth / Date de naissance<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-1f92r3b"><input data-client-id="date_Date of Birth / Date de naissance" id="date_Date of Birth / Date de naissance" aria-label="Date of Birth / Date de naissance" tabindex="0" name="Date of Birth / Date de naissance"
maxlength="100" class="css-1dpiipj epidubd0" value=""><button tabindex="0" type="button" aria-label="Choose" class="css-17q24xo"><span title="Choose a date" class="css-14atay6 e1yrjtds0"><svg xmlns="http://www.w3.org/2000/svg" role="img"
width="16" height="16" viewBox="0 0 16 16">
<title>Calendar Icon</title>
<desc>Calendar</desc>
<g fill="none" fill-rule="evenodd">
<rect width="13" height="13" x="2" y="2" fill="#005EE0" rx="1"></rect>
<path fill="#FFF"
d="M11.648 12h-.96V8.38c-.351.328-.765.571-1.241.728v-.871c.25-.082.523-.238.817-.467.294-.229.495-.496.605-.801h.779V12zm-6.385-1.33l.93-.112c.03.237.11.418.24.543.129.125.286.188.47.188a.648.648 0 0 0 .502-.226c.135-.15.203-.353.203-.608 0-.241-.065-.433-.195-.574a.621.621 0 0 0-.475-.212c-.123 0-.27.024-.44.072l.105-.783c.26.007.458-.05.595-.17a.602.602 0 0 0 .205-.476.545.545 0 0 0-.15-.403.54.54 0 0 0-.4-.15.579.579 0 0 0-.42.17c-.117.114-.188.28-.213.5l-.885-.151c.061-.303.154-.545.279-.726.124-.182.297-.324.52-.428.221-.103.47-.155.746-.155.472 0 .85.15 1.135.45.234.247.352.525.352.835 0 .44-.24.79-.721 1.053.287.061.516.199.688.413a1.2 1.2 0 0 1 .258.776c0 .44-.16.815-.482 1.125-.32.31-.72.464-1.2.464-.453 0-.829-.13-1.127-.39a1.538 1.538 0 0 1-.52-1.025zM11 5a1 1 0 1 1 0-2 1 1 0 0 1 0 2zM6 5a1 1 0 1 1 0-2 1 1 0 0 1 0 2z">
</path>
</g>
</svg></span></button></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Gender / Genre" data-client-type="dropdown" id="J3XQWkQ" class="css-u3yn36 ef83ajd0"><label for="select_input_Gender / Genre" id="ad63f60a-7994-4dbc-a394-0ef4c37cc12d"
data-client-id="label_Gender / Genre" class="css-1xl1v40 ekxsfat0">Gender / Genre<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="rich-text-field-desc css-1q4upac" id="description_select_input_Gender___Genre">
<p>You can select more than one option / Vous pouvez sélectionner plus d’une option.</p>
</div>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container react-select__value-container--is-multi">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select or enter value</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Gender / Genre" spellcheck="false" tabindex="0" type="text"
aria-label="Select or enter value" aria-labelledby="ad63f60a-7994-4dbc-a394-0ef4c37cc12d" value="" aria-describedby="description_select_input_Gender___Genre"
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Language Preferred/langue préférée" data-client-type="dropdown" id="2gkL0RDl" class="css-u3yn36 ef83ajd0"><label for="select_input_Language Preferred/langue préférée"
id="7fdfacc3-e0ad-489a-9bee-2fda187240db" data-client-id="label_Language Preferred/langue préférée" class="css-1xl1v40 ekxsfat0">Language Preferred/langue préférée<span data-client-id="required_indicator"
class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Language Preferred/langue préférée" spellcheck="false" tabindex="0" type="text"
aria-label="Select" aria-labelledby="7fdfacc3-e0ad-489a-9bee-2fda187240db" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Province/Territoire" data-client-type="dropdown" id="GznoR6Nr" class="css-u3yn36 ef83ajd0"><label for="select_input_Province/Territoire" id="a418987a-6ecd-4bfe-a196-9766b97d0b7c"
data-client-id="label_Province/Territoire" class="css-1xl1v40 ekxsfat0">Province/Territoire<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Province/Territoire" spellcheck="false" tabindex="0" type="text" aria-label="Select"
aria-labelledby="a418987a-6ecd-4bfe-a196-9766b97d0b7c" value="" style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Postal Code/Code Postal" data-client-type="text" id="eRDv7zjg" class="css-1e3khfm ef83ajd0"><label for="text_box_Postal Code/Code Postal" data-client-id="label_Postal Code/Code Postal"
class="css-1xl1v40 ekxsfat0">Postal Code/Code Postal<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div id="description_Postal_Code_Code_Postal" class="rich-text-field-desc">
<p>Please ensure you add your postal code, otherwise your application will be delayed. / Assurez-vous d’ajouter votre code postal, sinon le traitement de votre dossier pourrait être retardé.</p>
</div>
<div style="display: flex;"><input title="" aria-invalid="false" aria-describedby="description_Postal_Code_Code_Postal" tabindex="0" id="text_box_Postal Code/Code Postal" data-client-id="text_box_Postal Code/Code Postal" data-client-type=""
name="eRDv7zjg" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Citizenship Status / Statut de citoyenneté" data-client-type="dropdown" id="ZwDaM6q" class="css-u3yn36 ef83ajd0"><label for="select_input_Citizenship Status / Statut de citoyenneté"
id="fbffa458-8aea-40ce-bede-1483c2d4c260" data-client-id="label_Citizenship Status / Statut de citoyenneté" class="css-1xl1v40 ekxsfat0">Citizenship Status / Statut de citoyenneté<span data-client-id="required_indicator"
class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Citizenship Status / Statut de citoyenneté" spellcheck="false" tabindex="0" type="text"
aria-label="Select" aria-labelledby="fbffa458-8aea-40ce-bede-1483c2d4c260" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
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</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Are you a part of the 2SLGBTQI+ Community / Faites-vous partie de la communauté LGBTQ+ ?" data-client-type="dropdown" id="yMyOQENY" class="css-u3yn36 ef83ajd0"><label
for="select_input_Are you a part of the 2SLGBTQI+ Community / Faites-vous partie de la communauté LGBTQ+ ?" id="a2471f05-56f6-45ed-866a-814ce2a6245b"
data-client-id="label_Are you a part of the 2SLGBTQI+ Community / Faites-vous partie de la communauté LGBTQ+ ?" class="css-1xl1v40 ekxsfat0">Are you a part of the 2SLGBTQI+ Community / Faites-vous partie de la communauté LGBTQ+ ?<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Are you a part of the 2SLGBTQI+ Community / Faites-vous partie de la communauté LGBTQ+ ?"
spellcheck="false" tabindex="0" type="text" aria-label="Select" aria-labelledby="a2471f05-56f6-45ed-866a-814ce2a6245b" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
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</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Black Canadian / Noir canadien" data-client-type="dropdown" id="61KXZd9" class="css-u3yn36 ef83ajd0"><label for="select_input_Black Canadian / Noir canadien"
id="fb2c5947-4e04-4700-81b1-79cd1163d1e1" data-client-id="label_Black Canadian / Noir canadien" class="css-1xl1v40 ekxsfat0">Black Canadian / Noir canadien<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Black Canadian / Noir canadien" spellcheck="false" tabindex="0" type="text"
aria-label="Select" aria-labelledby="fb2c5947-4e04-4700-81b1-79cd1163d1e1" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Person with disability(ies) / Personnes handicapées" data-client-type="dropdown" id="GKXo6jA" class="css-u3yn36 ef83ajd0"><label
for="select_input_Person with disability(ies) / Personnes handicapées" id="0ea9088b-5631-4740-9dc3-2ee63d79bc6a" data-client-id="label_Person with disability(ies) / Personnes handicapées" class="css-1xl1v40 ekxsfat0">Person with
disability(ies) / Personnes handicapées<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Person with disability(ies) / Personnes handicapées" spellcheck="false" tabindex="0"
type="text" aria-label="Select" aria-labelledby="0ea9088b-5631-4740-9dc3-2ee63d79bc6a" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Indigenous / Autochtone" data-client-type="dropdown" id="A9lAYvK" class="css-u3yn36 ef83ajd0"><label for="select_input_Indigenous / Autochtone" id="b48cb3fd-193e-4b7b-ae16-b7bb2f67e76a"
data-client-id="label_Indigenous / Autochtone" class="css-1xl1v40 ekxsfat0">Indigenous / Autochtone<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select or enter value</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Indigenous / Autochtone" spellcheck="false" tabindex="0" type="text"
aria-label="Select or enter value" aria-labelledby="b48cb3fd-193e-4b7b-ae16-b7bb2f67e76a" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Newcommer to Canada / Nouveaux arrivants au Canada" data-client-type="dropdown" id="Rv7bW1v" class="css-u3yn36 ef83ajd0"><label
for="select_input_Newcommer to Canada / Nouveaux arrivants au Canada" id="e026b007-8dfd-48ca-9ea3-6f3744192b1f" data-client-id="label_Newcommer to Canada / Nouveaux arrivants au Canada" class="css-1xl1v40 ekxsfat0">Newcommer to Canada /
Nouveaux arrivants au Canada<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="rich-text-field-desc css-1q4upac" id="description_select_input_Newcommer_to_Canada___Nouveaux_arrivants_au_Canada">
<p>0 to 5 years / 0 à 5 ans</p>
</div>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Newcommer to Canada / Nouveaux arrivants au Canada" spellcheck="false" tabindex="0"
type="text" aria-label="Select" aria-labelledby="e026b007-8dfd-48ca-9ea3-6f3744192b1f" value="" aria-describedby="description_select_input_Newcommer_to_Canada___Nouveaux_arrivants_au_Canada"
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Other racialized communities or visible minority / Autres communautés racisées ou minorités visibles" data-client-type="dropdown" id="32AkwyX" class="css-u3yn36 ef83ajd0"><label
for="select_input_Other racialized communities or visible minority / Autres communautés racisées ou minorités visibles" id="60ec94e7-61ee-4107-8f6c-1322d6483921"
data-client-id="label_Other racialized communities or visible minority / Autres communautés racisées ou minorités visibles" class="css-1xl1v40 ekxsfat0">Other racialized communities or visible minority / Autres communautés racisées ou
minorités visibles<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="rich-text-field-desc css-1q4upac" id="description_select_input_Other_racialized_communities_or_visible_minority___Autres_communaut_s_racis_es_ou_minorit_s_visibles">
<p>South Asian, Chinese, Filipino, Latin American, Arab, Southeast Asian (Vietnamese/Cambodian/Laotian/Thai), West Asian (Iranian/Afghan), Korean, Japenese, Other</p>
<p><br></p>
<p>Asiatique du sud, Chinois, Philippin, Latino-Américain, Arabe, Asiatique du sud-est (Vietnamien/Cambodgien/Laotien/Thaï), Asiatique de l’ouest (Iranien/Afghan), Coréen, Japonais, autre</p>
</div>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off"
id="select_input_Other racialized communities or visible minority / Autres communautés racisées ou minorités visibles" spellcheck="false" tabindex="0" type="text" aria-label="Select"
aria-labelledby="60ec94e7-61ee-4107-8f6c-1322d6483921" value="" aria-describedby="description_select_input_Other_racialized_communities_or_visible_minority___Autres_communaut_s_racis_es_ou_minorit_s_visibles"
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Highest Level of Education attained / Le plus haut niveau d'éducation atteint" data-client-type="dropdown" id="QRlN72Pw" class="css-u3yn36 ef83ajd0"><label
for="select_input_Highest Level of Education attained / Le plus haut niveau d'éducation atteint" id="c0fe66c6-7a15-40e6-b8e2-3517d5909686" data-client-id="label_Highest Level of Education attained / Le plus haut niveau d'éducation atteint"
class="css-1xl1v40 ekxsfat0">Highest Level of Education attained / Le plus haut niveau d'éducation atteint<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="rich-text-field-desc css-1q4upac" id="description_select_input_Highest_Level_of_Education_attained___Le_plus_haut_niveau_d__ducation_atteint">
<p>Please choose an option to avoid a delay in your application. / Veuillez choisir une option pour éviter un délai dans le traitement de votre dossier.</p>
</div>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Highest Level of Education attained / Le plus haut niveau d'éducation atteint"
spellcheck="false" tabindex="0" type="text" aria-label="Select" aria-labelledby="c0fe66c6-7a15-40e6-b8e2-3517d5909686" value=""
aria-describedby="description_select_input_Highest_Level_of_Education_attained___Le_plus_haut_niveau_d__ducation_atteint"
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
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</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Year completed/Année complétée" data-client-type="dropdown" id="r75nkGn1" class="css-u3yn36 ef83ajd0"><label for="select_input_Year completed/Année complétée"
id="32c43177-c156-4827-94e1-6c4ea54b4491" data-client-id="label_Year completed/Année complétée" class="css-1xl1v40 ekxsfat0">Year completed/Année complétée<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Year completed/Année complétée" spellcheck="false" tabindex="0" type="text"
aria-label="Select" aria-labelledby="32c43177-c156-4827-94e1-6c4ea54b4491" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
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</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Were you employed before this program? / Étiez-vous en emploi avant ce programme?" data-client-type="dropdown" id="Rv7N0n1" class="css-u3yn36 ef83ajd0"><label
for="select_input_Were you employed before this program? / Étiez-vous en emploi avant ce programme?" id="04c3798c-0aed-4ec1-926a-ee1859241ed7"
data-client-id="label_Were you employed before this program? / Étiez-vous en emploi avant ce programme?" class="css-1xl1v40 ekxsfat0">Were you employed before this program? / Étiez-vous en emploi avant ce programme?<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Were you employed before this program? / Étiez-vous en emploi avant ce programme?"
spellcheck="false" tabindex="0" type="text" aria-label="Select" aria-labelledby="04c3798c-0aed-4ec1-926a-ee1859241ed7" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Were you unemployed for at least 6 months before this program? / Avez-vous été au chômage pendant au moins 6 mois avant ce programme?" data-client-type="dropdown" id="R5b7pYv1"
class="css-u3yn36 ef83ajd0"><label for="select_input_Were you unemployed for at least 6 months before this program? / Avez-vous été au chômage pendant au moins 6 mois avant ce programme?" id="3f306171-10da-49e9-aa08-f1f0e2bc0797"
data-client-id="label_Were you unemployed for at least 6 months before this program? / Avez-vous été au chômage pendant au moins 6 mois avant ce programme?" class="css-1xl1v40 ekxsfat0">Were you unemployed for at least 6 months before this
program? / Avez-vous été au chômage pendant au moins 6 mois avant ce programme?<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off"
id="select_input_Were you unemployed for at least 6 months before this program? / Avez-vous été au chômage pendant au moins 6 mois avant ce programme?" spellcheck="false" tabindex="0" type="text" aria-label="Select"
aria-labelledby="3f306171-10da-49e9-aa08-f1f0e2bc0797" value="" style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div role="application" title="" data-client-id="container_If No, were you employed full-time or part-time? / Si non, étiez-vous employé à temps plein ou à temps partiel?" data-client-type="dropdown" id="pdanMrkY" class="css-u3yn36 ef83ajd0">
<label for="select_input_If No, were you employed full-time or part-time? / Si non, étiez-vous employé à temps plein ou à temps partiel?" id="04f06489-7e24-4be3-ae0f-7eecfdde3528"
data-client-id="label_If No, were you employed full-time or part-time? / Si non, étiez-vous employé à temps plein ou à temps partiel?" class="css-1xl1v40 ekxsfat0">If No, were you employed full-time or part-time? / Si non, étiez-vous employé
à temps plein ou à temps partiel?<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select or enter value</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off"
id="select_input_If No, were you employed full-time or part-time? / Si non, étiez-vous employé à temps plein ou à temps partiel?" spellcheck="false" tabindex="-1" type="text" aria-label="Select or enter value"
aria-labelledby="04f06489-7e24-4be3-ae0f-7eecfdde3528" value="" style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
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</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Enrolled in Driver Training or Employee? / Inscrit à la formation de chauffeur ou employé?" data-client-type="dropdown" id="0q7nkyRj" class="css-u3yn36 ef83ajd0"><label
for="select_input_Enrolled in Driver Training or Employee? / Inscrit à la formation de chauffeur ou employé?" id="d2cfb83d-3304-41bd-86d7-addb158bd4a3"
data-client-id="label_Enrolled in Driver Training or Employee? / Inscrit à la formation de chauffeur ou employé?" class="css-1xl1v40 ekxsfat0">Enrolled in Driver Training or Employee? / Inscrit à la formation de chauffeur ou employé?<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off"
id="select_input_Enrolled in Driver Training or Employee? / Inscrit à la formation de chauffeur ou employé?" spellcheck="false" tabindex="0" type="text" aria-label="Select" aria-labelledby="d2cfb83d-3304-41bd-86d7-addb158bd4a3"
value="" style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Job Title/Titre d'emploi" data-client-type="text" id="OOlz5WlP" class="css-1e3khfm ef83ajd0"><label for="text_box_Job Title/Titre d'emploi" data-client-id="label_Job Title/Titre d'emploi"
class="css-1xl1v40 ekxsfat0">Job Title/Titre d'emploi<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Job Title/Titre d'emploi" data-client-id="text_box_Job Title/Titre d'emploi" data-client-type="" name="OOlz5WlP" maxlength="4000"
class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Driver Training Institution name / Nom de l’établissement de formation de chauffeurs" data-client-type="text" id="rmZzgEv" class="css-1e3khfm ef83ajd0"><label
for="text_box_Driver Training Institution name / Nom de l’établissement de formation de chauffeurs" data-client-id="label_Driver Training Institution name / Nom de l’établissement de formation de chauffeurs"
class="css-1xl1v40 ekxsfat0">Driver Training Institution name / Nom de l’établissement de formation de chauffeurs<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Driver Training Institution name / Nom de l’établissement de formation de chauffeurs"
data-client-id="text_box_Driver Training Institution name / Nom de l’établissement de formation de chauffeurs" data-client-type="" name="rmZzgEv" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Institution address / Adresse de l’établissement" data-client-type="text" id="EWQ3ANY" class="css-1e3khfm ef83ajd0"><label for="text_box_Institution address / Adresse de l’établissement"
data-client-id="label_Institution address / Adresse de l’établissement" class="css-1xl1v40 ekxsfat0">Institution address / Adresse de l’établissement<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Institution address / Adresse de l’établissement" data-client-id="text_box_Institution address / Adresse de l’établissement" data-client-type=""
name="EWQ3ANY" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Institution contact person / Personne contact à l’établissement" data-client-type="text" id="bRlY6r6" class="css-1e3khfm ef83ajd0"><label
for="text_box_Institution contact person / Personne contact à l’établissement" data-client-id="label_Institution contact person / Personne contact à l’établissement" class="css-1xl1v40 ekxsfat0">Institution contact person / Personne contact à
l’établissement<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Institution contact person / Personne contact à l’établissement"
data-client-id="text_box_Institution contact person / Personne contact à l’établissement" data-client-type="" name="bRlY6r6" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Institution email address / Adresse courriel de l’établissement" data-client-type="text" id="3NnvrGL" class="css-1e3khfm ef83ajd0"><label
for="text_box_Institution email address / Adresse courriel de l’établissement" data-client-id="label_Institution email address / Adresse courriel de l’établissement" class="css-1xl1v40 ekxsfat0">Institution email address / Adresse courriel de
l’établissement<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Institution email address / Adresse courriel de l’établissement"
data-client-id="text_box_Institution email address / Adresse courriel de l’établissement" data-client-type="" name="3NnvrGL" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Training start date / Date de début de la formation" data-client-type="date" id="bMMra6Gl" class="css-gbq6lm ef83ajd0"><label for="date_Training start date / Date de début de la formation"
data-client-id="label_Training start date / Date de début de la formation" class="css-1xl1v40 ekxsfat0">Training start date / Date de début de la formation<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-1f92r3b"><input data-client-id="date_Training start date / Date de début de la formation" id="date_Training start date / Date de début de la formation" aria-label="Training start date / Date de début de la formation"
tabindex="-1" name="Training start date / Date de début de la formation" maxlength="100" class="css-1dpiipj epidubd0" value=""><button tabindex="-1" type="button" aria-label="Choose" class="css-17q24xo"><span title="Choose a date"
class="css-14atay6 e1yrjtds0"><svg xmlns="http://www.w3.org/2000/svg" role="img" width="16" height="16" viewBox="0 0 16 16">
<title>Calendar Icon</title>
<desc>Calendar</desc>
<g fill="none" fill-rule="evenodd">
<rect width="13" height="13" x="2" y="2" fill="#005EE0" rx="1"></rect>
<path fill="#FFF"
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</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Training End Date / Date de fin de la formation" data-client-type="date" id="QRRLQ8ZD" class="css-gbq6lm ef83ajd0"><label for="date_Training End Date / Date de fin de la formation"
data-client-id="label_Training End Date / Date de fin de la formation" class="css-1xl1v40 ekxsfat0">Training End Date / Date de fin de la formation<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-1f92r3b"><input data-client-id="date_Training End Date / Date de fin de la formation" id="date_Training End Date / Date de fin de la formation" aria-label="Training End Date / Date de fin de la formation" tabindex="-1"
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class="css-14atay6 e1yrjtds0"><svg xmlns="http://www.w3.org/2000/svg" role="img" width="16" height="16" viewBox="0 0 16 16">
<title>Calendar Icon</title>
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<g fill="none" fill-rule="evenodd">
<rect width="13" height="13" x="2" y="2" fill="#005EE0" rx="1"></rect>
<path fill="#FFF"
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</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Institution Phone number / Numéro de téléphone de l’établissement" data-client-type="text" id="8Rnpqv1" class="css-1e3khfm ef83ajd0"><label
for="text_box_Institution Phone number / Numéro de téléphone de l’établissement" data-client-id="label_Institution Phone number / Numéro de téléphone de l’établissement" class="css-1xl1v40 ekxsfat0">Institution Phone number / Numéro de
téléphone de l’établissement<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;">
<div class=" react-tel-input" style="height: 35px; width: 40px;">
<div class="special-label">Phone</div><input class=" form-control" placeholder="1 (702) 123-4567" type="tel" name="8Rnpqv1" aria-hidden="true" aria-label="phone picker" value="+1" style="display: none;">
<div class=" flag-dropdown">
<div class="selected-flag" title="United States: + 1" tabindex="0" role="button" aria-haspopup="listbox">
<div class="flag us">
<div class="arrow"></div>
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</div><input aria-invalid="false" tabindex="-1" id="text_box_Institution Phone number / Numéro de téléphone de l’établissement" data-client-id="text_box_Institution Phone number / Numéro de téléphone de l’établissement"
data-client-type="PHONE" type="text" value="+1 (___) ___-____" inputmode="numeric">
</div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div role="application" title="" data-client-id="container_Do you need support for living and transportation expenses during this training? / Avez-vous besoin de soutien pour vos frais de subsistance et de transport pendant cette formation?"
data-client-type="dropdown" id="6ERbeqv" class="css-u3yn36 ef83ajd0"><label
for="select_input_Do you need support for living and transportation expenses during this training? / Avez-vous besoin de soutien pour vos frais de subsistance et de transport pendant cette formation?" id="ec5ac75a-e79d-41bc-bcbe-11780fcc21c6"
data-client-id="label_Do you need support for living and transportation expenses during this training? / Avez-vous besoin de soutien pour vos frais de subsistance et de transport pendant cette formation?" class="css-1xl1v40 ekxsfat0">Do you
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class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
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<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
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<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off"
id="select_input_Do you need support for living and transportation expenses during this training? / Avez-vous besoin de soutien pour vos frais de subsistance et de transport pendant cette formation?" spellcheck="false" tabindex="-1"
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style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
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<path
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<div class="css-tkslta e1tmc1mx0">
<div role="application" title="" data-client-id="container_Consent" data-client-type="dropdown" id="k9L7yX3" class="css-u3yn36 ef83ajd0"><label for="select_input_Consent" id="8229a7aa-ed52-4ed4-a363-138aa53ae847" data-client-id="label_Consent"
class="css-1xl1v40 ekxsfat0">Consent<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="rich-text-field-desc css-1q4upac" id="description_select_input_Consent">
<p><strong>I consent to the collection, uses and disclosure of the information provided in this form to Canada (the Government of Canada), and I attest that all the information I have provided is correct.</strong></p>
<p><br></p>
<p><strong>I agree to participate in Trucking HR Canada's Career ExpressWay Program as funded in part by the Government of Canada. </strong></p>
<p><br></p>
<p>Je consens à la cueillette, à l’utilisation et à la divulgation de l’information contenue dans ce formulaire au Canada (le gouvernement du Canada) et j’atteste que toute l’information que j’ai fournie est exacte.</p>
<p>Je consens à participer au programme Carrière sur la voie rapide de RH Camionnage Canada, tel que financé en partie par le gouvernement du Canada.</p>
</div>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Consent" spellcheck="false" tabindex="-1" type="text" aria-label="Select"
aria-labelledby="8229a7aa-ed52-4ed4-a363-138aa53ae847" value="" aria-describedby="description_select_input_Consent"
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
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<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
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</div>
</div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Driver Training Agreement Form" data-client-type="text" id="70j0wvqR" class="css-1e3khfm ef83ajd0"><label for="text_box_Driver Training Agreement Form" data-client-id="label_Driver Training Agreement Form"
class="css-1xl1v40 ekxsfat0">Driver Training Agreement Form</label>
<div id="description_Driver_Training_Agreement_Form" class="rich-text-field-desc">
<p>Click on this <a style="color: rgb(0, 138, 0);" rel="nofollow noreferrer noopener" href="https://truckinghr-my.sharepoint.com/:b:/p/aani/EYVOPJ4dxTVBr7lqv0PAaiMBzs5ClZMU5KIvjzGECjlLmw?e=XHrP14"><strong>LINK</strong></a><strong> </strong>to
download the
<a style="color: rgb(0, 138, 0);" rel="nofollow noreferrer noopener" href="https://truckinghr-my.sharepoint.com/:b:/p/aani/EYVOPJ4dxTVBr7lqv0PAaiMBzs5ClZMU5KIvjzGECjlLmw?e=XHrP14"><strong>Driver Training Agreement Form</strong></a>,
complete it, sign and attach it to the Driver Agreement Form placeholder below.</p>
<p><br></p>
<p><br></p>
<p>Cliquez sur ce <a style="color: rgb(0, 97, 0);" rel="nofollow noreferrer noopener" href="https://truckinghr-my.sharepoint.com/:b:/p/aani/ERE6WQZ9TKdGvzX6AxBGt4oBy4O-0ZVKDW6Kv6VWwumGvA?e=9m6nd2"><strong>LIEN</strong></a><strong>
</strong>pour
télécharger<a style="color: rgb(0, 97, 0);" rel="nofollow noreferrer noopener" href="https://truckinghr-my.sharepoint.com/:b:/p/aani/ERE6WQZ9TKdGvzX6AxBGt4oBy4O-0ZVKDW6Kv6VWwumGvA?e=9m6nd2"><strong> le formulaire d’entente de formation de chauffeur</strong></a><strong>,</strong>
le compléter, le signer et le joindre au formulaire d’entente de chauffeur à l’endroit réservé ci-dessous.</p>
</div>
<div style="display: flex;"><input title="" aria-invalid="false" aria-describedby="description_Driver_Training_Agreement_Form" tabindex="-1" id="text_box_Driver Training Agreement Form" data-client-id="text_box_Driver Training Agreement Form"
data-client-type="" name="70j0wvqR" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Driver Agreement Form" data-client-type="file_upload" id="ATTACHMENT" class="css-1ylo82b ef83ajd0"><label for="file_upload_Driver Agreement Form" data-client-id="label_Driver Agreement Form"
class="css-1xl1v40 ekxsfat0">Driver Agreement Form<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-vqlje4" tabindex="-1" data-client-id="file_upload_dropzone" aria-disabled="false" style="position: relative;">
<div class="css-hvudvc eo18oon8"><span class="css-1btvv3a eo18oon1"><span>Drag and drop files here or </span> <button tabindex="-1" type="button" class="css-uro7iq eo18oon0"><span>browse files</span></button></span></div><input
id="file_upload_Driver Agreement Form" tabindex="-1" type="file" multiple="" autocomplete="off" style="position: absolute; inset: 0px; opacity: 1e-05; pointer-events: none;">
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<hr data-client-id="email_receipt" class="css-1xs1ymt e14sboee2">
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<div class="css-1gl0c9l excyp8g0"><label class="css-1y93uaa excyp8g1"><input data-client-id="email_receipt_checkbox" name="EMAIL_RECEIPT_CHECKBOX" type="checkbox" class="css-1czgm8r excyp8g2" value="false"><span>Send me a copy of my
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<div class="css-1ock8o4 e1xpzprc2"><button data-client-id="form_submit_btn" disabled="" type="submit" value="submit" class="css-oltpmt e1xpzprc0"><span>Submit</span></button></div>
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style="margin: 0px 5px;">|</span><a target="_blank" href="https://app.smartsheet.com/b/reportabuse?EQBCT=90a0ead7213944bc9983f73a3178b4b9" rel="noopener noreferrer" data-client-id="footer_reportAbuse" class="css-a7ff3e e8i4qwl2"><span>Report Abuse</span></a>
</div>
</div>
</form>Text Content
Career ExpressWay Participant Information Form Formulaire d’information sur le participant This information is administered with the Privacy Act (R.S.C., 1985, c. P-21) and the Department of Employment and Social Development Canada Act (S.C. 2005, c. 34) and you have a right under the Access to Information Act (R.S.C., 1985, c. A-1) to obtain access to this information from Canada. Cette information est gérée en vertu de la Loi sur la protection des renseignements personnels (L.R.C. (1985), ch. P-21) et de la Loi sur le ministère de l’Emploi et du Développement social (L.C. 2005, ch. 34) et vous avez le droit, en vertu de la Loi sur l’accès à l’information (L.R.C. (1985), ch. A-1), d’obtenir cette information du Canada. Company name / Nom de l’entreprise* This is the company that submitted your details for the subsidy program C’est l’entreprise qui a soumis vos informations pour le programme de subvention First Name (as it appears on SIN card) / Prénom (tel qu’il apparaît sur la carte NAS)* Last Name (as it appears on SIN card) / Nom de famille (tel qu’il apparaît sur la carte NAS)* Social Insurance Number / Numéro d’assurance sociale* Email/Courriel* Personal email address / Adresse courriel personnelle Phone number / Numéro de téléphone* Personal phone number / Numéro de téléphone personnel Phone Date of Birth / Date de naissance* Calendar IconCalendar Gender / Genre* You can select more than one option / Vous pouvez sélectionner plus d’une option. Select or enter value Caret IconCaret symbol Language Preferred/langue préférée* Select Caret IconCaret symbol Province/Territoire* Select Caret IconCaret symbol Postal Code/Code Postal* Please ensure you add your postal code, otherwise your application will be delayed. / Assurez-vous d’ajouter votre code postal, sinon le traitement de votre dossier pourrait être retardé. Citizenship Status / Statut de citoyenneté* Select Caret IconCaret symbol Are you a part of the 2SLGBTQI+ Community / Faites-vous partie de la communauté LGBTQ+ ?* Select Caret IconCaret symbol Black Canadian / Noir canadien* Select Caret IconCaret symbol Person with disability(ies) / Personnes handicapées* Select Caret IconCaret symbol Indigenous / Autochtone* Select or enter value Caret IconCaret symbol Newcommer to Canada / Nouveaux arrivants au Canada* 0 to 5 years / 0 à 5 ans Select Caret IconCaret symbol Other racialized communities or visible minority / Autres communautés racisées ou minorités visibles* South Asian, Chinese, Filipino, Latin American, Arab, Southeast Asian (Vietnamese/Cambodian/Laotian/Thai), West Asian (Iranian/Afghan), Korean, Japenese, Other Asiatique du sud, Chinois, Philippin, Latino-Américain, Arabe, Asiatique du sud-est (Vietnamien/Cambodgien/Laotien/Thaï), Asiatique de l’ouest (Iranien/Afghan), Coréen, Japonais, autre Select Caret IconCaret symbol Highest Level of Education attained / Le plus haut niveau d'éducation atteint* Please choose an option to avoid a delay in your application. / Veuillez choisir une option pour éviter un délai dans le traitement de votre dossier. Select Caret IconCaret symbol Year completed/Année complétée* Select Caret IconCaret symbol Were you employed before this program? / Étiez-vous en emploi avant ce programme?* Select Caret IconCaret symbol Were you unemployed for at least 6 months before this program? / Avez-vous été au chômage pendant au moins 6 mois avant ce programme?* Select Caret IconCaret symbol If No, were you employed full-time or part-time? / Si non, étiez-vous employé à temps plein ou à temps partiel?* Select or enter value Caret IconCaret symbol Enrolled in Driver Training or Employee? / Inscrit à la formation de chauffeur ou employé?* Select Caret IconCaret symbol Job Title/Titre d'emploi* Driver Training Institution name / Nom de l’établissement de formation de chauffeurs* Institution address / Adresse de l’établissement* Institution contact person / Personne contact à l’établissement* Institution email address / Adresse courriel de l’établissement* Training start date / Date de début de la formation* Calendar IconCalendar Training End Date / Date de fin de la formation* Calendar IconCalendar Institution Phone number / Numéro de téléphone de l’établissement* Phone Do you need support for living and transportation expenses during this training? / Avez-vous besoin de soutien pour vos frais de subsistance et de transport pendant cette formation?* Select Caret IconCaret symbol Consent* I consent to the collection, uses and disclosure of the information provided in this form to Canada (the Government of Canada), and I attest that all the information I have provided is correct. I agree to participate in Trucking HR Canada's Career ExpressWay Program as funded in part by the Government of Canada. Je consens à la cueillette, à l’utilisation et à la divulgation de l’information contenue dans ce formulaire au Canada (le gouvernement du Canada) et j’atteste que toute l’information que j’ai fournie est exacte. Je consens à participer au programme Carrière sur la voie rapide de RH Camionnage Canada, tel que financé en partie par le gouvernement du Canada. Select Caret IconCaret symbol Driver Training Agreement Form Click on this LINK to download the Driver Training Agreement Form, complete it, sign and attach it to the Driver Agreement Form placeholder below. Cliquez sur ce LIEN pour télécharger le formulaire d’entente de formation de chauffeur, le compléter, le signer et le joindre au formulaire d’entente de chauffeur à l’endroit réservé ci-dessous. Driver Agreement Form* Drag and drop files here or browse files -------------------------------------------------------------------------------- Send me a copy of my responses Submit Privacy Notice|Report Abuse