Yukon Government Participant InformationPlease enable JavaScript in your browser to complete this form.Name *FirstLastDOB & SINSIN NumberDate of Birth *Contact DetailsPhoneEmail *Address *Address Line 1CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryStatistical InformationWhich gender do you identify with? *FemaleMaleOtherPrefer not to reportDo you have a diability? *YesNoPrefer not to reportDo you identify as indigenous? *YesNoPrefer not to reportAre you an immigrant? *YesNoPrefer not to reportWhat year did you immigrate?Are you a visible minority? *YesNoPrefer not to reportWhat is your marital status? *SingleMarried or EquivalentPrefer not to reportNumber of dependents you have?Leave blank if you prefer not to report.Education InformationEnter "Unknown" if you are unsure.EducationWhat is your highest level of education? *What country did you study in?Canada/USOtherCompleted in what year?Prov./Terr./StateWhat country?Education YearsApproximate start dateApproximate date of education start?Approximate finish dateApproximate date of education finish?Employment GoalsLayoutJob PreferenceNOCCollection, use and disclosure of personal information The personal information you provide is collected for the purpose of administering post-secondary and labour market programs and services. It will be shared with the following organizations: Employment and Social Development Canada under the authority of the Employment Insurance Act and/orthe Department of Employment and Social Development Act; In cases where you are making an application for funding support: Canada Revenue Agency under theauthority of the Income Tax Act; Government of Yukon, Department of Justice under the authority of the Maintenance Enforcement Act. Your information will also be shared with the following: Your case manager(s) who have helped you with your action plan, your Working UP application, andongoing support persons. Any third party that you have specifically accepted a referral to by your case manager or Department of Education staff as part of your Action Plan. The information you provide may also be used for policy analysis, statistical, research and/or program evaluation purposes by the Government of Yukon and the Government of Canada. This information is collected and managed in accordance with the Access to Information and Protection of Privacy Act, R.S.Y., 2002, c.1 (the “Act”). Records and information pertaining to this application may be disclosed to third parties only in accordance with the Act. Other than as stated above, your information will not be shared with any individual or organization without your specific, written consent. Questions? Please contact: The Director: Post Secondary & Labour Market Unit Policy and Partnerships Branch, Department of Education Box 2703, Whitehorse YT Y1A 2C6 Phone 867-667-5727 or 1-800-661-0408 ext. 5906. Name of Participant *Signature *Clear SignatureDateSubmit Downloadable Form YG-Participant-InformationPDF