LBS Participant Registration Form (PRF)

Instructions

Page 1

NOTE: To avoid confusion with dates – use the following format: April 1/12

Field Name / Mandatory Yes or No / Notes
Case Reference # / NO / Auto-generated by EOIS CaMS
Person Reference # / NO / Auto-generated by EOIS CaMS
Name, First and Last / Yes / Ensure legal name is used
Gender / Yes
Date of Birth / Yes / Please use format – Apr 14/87 to avoid confusion
Registration Date / Yes / Learner’s start date in the program (this is for program use only. Registration Date is auto-generated in CaMS)
Status in Canada / Yes / If Other: could be refugee, work permit, foreign student, etc.
Date arrived in Canada / No / Only required if not Canadian Citizen or Permanent Resident
Preferred Language of Service / Yes
Preferred Communication / No / Email, phone or mail
Marital Status / Yes / Addtl Options: Common Law, Divorced, Separated, Widowed
Designated Groups / No / Suitability Criteria derived from these answers (See “Guidelines for defining Designated Groups”)
Address
Primary Mailing / Yes / Ensure postal code matches address. Learner cannot be entered into CaMS without the proper postal code
Alternate Mailing / No
Contact Information / No
Education / Yes
Institution / Yes / School last attended
Qualification / Yes / Last grade or program COMPLETED: Grade 0-8, Grade 9, Grade 10, Grade 11, Grade 12, OAC, Some Apprenticeship, Some College, Some University, Certificate of Apprenticeship, Certificate/Diploma, Applied Degree, Bachelor’s Degree, Post Graduate – Program name if applicable ie: PSW, Marketing etc.
Dates / Yes / Approx dates such as: Sept 5/99 or Jun 30/05 if not known
Type / Yes
Country of Institution / Yes

PLEASE NOTE THESE SUITABILITY INDICATORS (measured as Performance Management targets)

·  Education Level attained: < grade 12

·  Source of Income: Ontario Works, ODSP, No source of income, Crown Ward

·  Time out of school, or training: 6 years or more

·  Age: older than 45 years of age and under 64

·  History of interrupted education: interrupted primary or secondary education

·  Person with disability: Self-identified as a person with a disability as defined by AODA

·  Aboriginal person: Self-identified as an Aboriginal person


LES Participant Registration Form

Instructions

Page 2

Field Name / Mandatory Yes or No / Notes
Employment / No / If entering employment data, all fields are mandatory except duties
Start and End Dates / Can be approximate if Learner is unsure
Reason for Leaving / Options: Another job, business closed, downsizing, end of contract, end of EO placement, end of season, fired, illness, immigrated to Canada, incarcerated, lockout, moved, other, pregnancy, project complete, retired, returned to school
Client Self Assessment / Yes
How long in Program / Yes / Does not need to be entered during 1st intake interview if unknown, but must be completed before opening a Service Plan in CaMS.
# of hours / Yes / Number of hours per week Learner plans to attend
Notice of Collection / Yes / Ensure Learner understands the agreement. Signature and date is required for both statements. If not signed, the Learner cannot participate in program. In some instances, an exception can be made by the Program Manager only. Signatures must be made in pen.


LES Participant Registration Form Instructions

Page 3

Field Name / Mandatory Yes or No / Notes
Referred in / Yes / Ask the question: How did you hear about our program?
Options: EO Employment Service Provider, EO Apprenticeship Office, EO LBS Provider, Informal Word of Mouth, Language Assessment, ODSP, OW, Probation/Parole Office, Service Canada, WSIB (Additional options are available in the dropdown menu in CaMS)
Service Delivery Site / Yes / Your centre
Owner / Yes / Your name
Template - Goal / Yes
Client Summary / Yes
Language / Yes / At home: ASL – American Sign Language
Workplace: addtl option: n/a
Service Provision: English
Source of Income / Yes / Main source of Learner income (are they receiving an income)
Employed: full-time, or part-time
Dependent of OW/ODSP – spouse or child 18 & over still in school
Other: WSIB, pension or investment income
Education / Yes / Should match answer from Page 1. Education COMPLETED only
Time out of education / Yes / If no education check ‘more than 6 years’
Time out of training / Yes / Training is specific to job skills (under 52 weeks) i.e., PSW, truck driving. If they have never had any training, check ‘more than 6 years’
History of Interrupted Education / Yes / Check ‘YES’ if the Learner’s regular school years were interrupted (Guideline – if Grade 12 Diploma not achieved by 18 years of age it is likely an interruption occurred.)
Employment / Yes
Labour force attachment / Yes / Status coming into the program – Learner is not yet considered a student in this program. If Learner is currently a student elsewhere, check full or part time student. If employed, check appropriate employment box. Underemployed, example: doctor working as a cabdriver, seasonal or temp work
Employment Experience / Yes
Time out of work / Yes / If never worked check ‘more than 6 years’
Assessment – Tool / Yes / Other – Locally Developed Tool
Date of Assessment / Yes / Date Assessment tool was used with Learner
Learner Gains Score / Yes / Zero – not developed by TCU as of yet
Field Name / Mandatory Yes or No / Notes
Date of Learner Gains score / No
Canadian Benchmark / No / 1-12 – CLB must be issued by a Canadian Language Benchmark Centre
Estimated Learner Wkly Time commitment / Yes / # of scheduled hours Learner plans to participate in Program – should be same as page 2
Add Sub-Goal/Plan Item / Yes / Identify Competencies and Task Groups the Learner will start working on while in program. These Competencies (Sub-Goals) can be modified in CaMS
Sub-Goal / Yes / Enter Competency Name and letter (A, B, C, D, E, F)
Plan Item / Yes / Enter Task Group Name and Number (numerical)
Expected Start Date / Yes / Expected date the Learner will start working on the skills required to achieve the tasks in the Competency
Expected End Date / Yes / Expected date the Learner will have the skills to achieve the Milestone identified
Expected Outcome / Yes / Competency level 1, 2, 3 or leave blank for the Competencies with no levels
Milestone / Yes / Enter numerical Milestone # based on the Competency and first level the Learner is anticipated to achieve (1-60)
Delivery Method / Yes / Classroom, One on One, or E-Channel
Blended Learning / Yes / Combination of Classroom or One on One with E-Channel or internet based learning environment