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Participant Information Form – Youth Employment and Skills Program

Instructions for completing this form

You can use either the PDF (52 KB) version of the form or the Web version below.

Please complete, print and send the form by email to or mail to your regional office or closest region.

Privacy statement

Personal information in the Participant Information form will be used to process the application and validate the eligibility of the participant in the Youth Employment and Skills Program and is being collected under the authority of the Department of Agriculture and Agri-Food Act. The personal information will be protected in accordance with the Privacy Act and will be described in Personal Information Bank AAFC PIB PPU 300 (Career Focus Program/Agricultural Youth Green Jobs Initiative). Information from this form may be disclosed to Employment and Social Development Canada for their evaluation of the Youth Employment and Skills Strategy initiative. You have the right to access your personal information held by Agriculture and Agri-food Canada and to request changes to incorrect personal information by contacting the AAFC Access to information and Privacy office at

Protected when completed - A

Part A. Project information - To be completed by the employer

3. Program/Activity:
Youth Employment and Skills Program

Part B. Participant information - To be completed by the participant

15. Employment status at start of intervention

16. Residency Status

17. Highest level of education completed

18. First official language

19. Language Spoken

20. Language written

21. Language preference

The Federal Government is committed to equity in employment. You are encouraged to complete the following voluntary questions and indicate if you are a member of any of these groups.

22. Gender

23. Member of a visible minority

24. Person with disability

25. Aboriginal group

26. Member of OLMC (Official Language Minority Community)

27. Recent Immigrant (within 3 years)

28. Youth barriers

Participants - Youth Employment and Skills Program

To assist us in capturing information on the youth programs as well as the results achieved, please indicate if you meet the following basic program criteria:

Basic Criteria

At the time of intake/selection, you were:

Participant Declaration

The purpose of the Youth Employment and Skills Strategy (YESS) is to provide a work experience that would facilitate the transition to the labour market. It is recommended that normally a young person has access to the Youth Employment and Skills Program under the YESS only once. To my knowledge, I certify that I have not participated in any of the Youth Employment and Skills Strategy Work Experience Programs targeted at post-secondary graduates.

Participant Signature (by hand only)

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