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APPLICATION FOR TRAINING & EMPLOYMENT SUPPORT

1 Training & Employment support applied for:
Job Development Program	Human Resource Investment Fund
Youth Development Program	Direct Purchase Program
Workplace Training Program	Service Delivery Assistance Program

2. Name of employer		3. Legal name of employer/coordinator/ group(if different)
4. Mailing address		5. City/Town	6. Province

7. Postal Code

8. Area code telephone no.

9. Area code fax no.

10. Business no.

11. Name of contact person

12. Telephone no. if different from above

13. no. of employees

If non profit organization provide:

Registration/Charter no.

Date

14. If for profit sector, state main product or service

15. Objective/Description of activities/targeted clientele/expected results (this section is mean executive summary. If a more detailed proposal is required, please attach the hard copy)  Band/Board motion of support included: Yes No

16. Location of activity

Designated group members targeting plan

17. Total no. of participants	18. No. of positions to be filled by:	19. Women	20. Aboriginals	21. Persons with disabilities	22. Members of visible minorities	23. Spare

24. Duration of activity	25. From	26. To	27. And from	28. To

Application form Continued pg. 2

OFFICIAL USE

150 Org. type	151 Emp. lang.	152 Train. lang.	153 Prov. riding.	154 STEPofficer	155 Constit	156 NOC	157 SIC	158 Activity	159 Yrs. of operation	160 Special Int. Gr.

161. National Spares Codes

162. Regional Spares Codes

163. HRCC Spares Codes

APPLICATION FOR TRAINING
AND SUPPORT Page 2

29 Occupations	30 No. of persons		31 No. of weeks	32 Total work weeks	33 Hours per week	34 Total hours	35 Wage rate per hour	36 Subsidy % requested	37 Subs. requested per hour	38 STEP contrib. requested	OFFICIAL USE ONLY
Col. 1	STAFF	Participants	Col. 3	Col. 4	Col. 5	Col. 6	Col. 7	Col. 8	Col. 9	Col. 10	Col. 11
Project Manager
Totals

Sources of other funds

Mandatory employment related costs W.C.B. Account No.W.C.B. rate %	Gross cost
Overhead Costs	Gross Cost
Total Participant daysTotal overhead costs
Training Costs	Gross Cost
Total Participant daysTotal training costs
Special costs	Gross costs
CAPITAL COSTSTotal Special Costs  TOTAL STEP CONTRIBUTION

I/We certify that each job to be created for a participant is in addition to employment planned for the period. Name Position

Date To be signed upon request.

Official use only Conditions of approval (if any) approvedRejectedWithdrawn		ParticipantsStaff Wage CostsTotal weeks
Approved by Date	TYPE 1 4 2 5 3 6	Training CostsOver Costs Spec CostsTotal Costs Fees PublicFees m-Public Recommended by

This application form page is currently under construction.

Payment Claim form

Training Plan form

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