Professional Documents
Culture Documents
It is important that you fill out this form completely, legibly and accurately. The information will be used by FEED NOVA SCOTIA to better understand each individual participants needs. All information will remain strictly confidential.
Full Name: Mailing Address: Telephone: Email: Date of Birth:
MM/DD/YY
Are you unemployed and not eligible for Employment Insurance (EI) benefits? Yes? No? In the past 5 years, have you received maternal/paternal employment insurance benefits? Yes? No? Education (most recent first):
Dates Attended (From / To) Institution Full or Part Time Graduated Yes / No Grade / Degree
Languages:
English: Other:
please specify
Speak
Read
Write
French:
Speak Speak
Read Read
Write Write
Work History: Please provide complete information on your last three jobs, starting with most recent. Food Service experience is not a requirement for admission to the program.
Employer: Address: City: Telephone: Position / Duties: Date of Employment (to/from): Reason for Leaving: Province:
Employer: Address: City: Telephone: Position / Duties: Date of Employment (to/from): Reason for Leaving: Province:
Employer: Address: City: Telephone: Position / Duties: Date of Employment (to/from): Reason for Leaving:
LK-004 Participant Application for Training X:\Policies & Procedures\Forms\Learning Kitchen\ February 2010 / Revised Oct 2010
Province:
Volunteer Experience: Place Dates (From / To) Position / Duties Name of Supervisor
I understand that the information on this application form will be used to consider my acceptance to the program and I certify that it is correct to the best of my knowledge. I permit FEED NOVA SCOTIA to check this information as they require. I also give permission to FEED NOVA SCOTIA to contact my Social Worker if I am in receipt of social assistance benefits. If accepted into FEED NOVA SCOTIAs Learning Kitchen Program, I agree to follow all policies, rules and regulations. Applicants Name: Applicants Signature: Date: FEED NOVA SCOTIAs Learning Kitchen 213 Bedford Highway Halifax NS B3M 2J9 T: (902) 457-1900 F: (902) 457-4500 learningkitchen@feednovascotia.ca
LK-004 Participant Application for Training X:\Policies & Procedures\Forms\Learning Kitchen\ February 2010 / Revised Oct 2010