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* PLEASE FILL OUT ALL REQUIRED FIELDS
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Company Name (required)
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Revenue Canada Number
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Street Address
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Nearest Major Intersection
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City
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Province
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Postal Code
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Contact Name (required)
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Contact Title (required)
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Telephone Number (required)
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Fax Number
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E-Mail (required)
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Have you ever participated in the Job Connect (JC) Program
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If yes, When?
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With which delivery agency?
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Training Site Address (if different than above)
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Position Title (required)
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Start Date (MM/DD/YY)
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Number of Positions Available
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Scheduled Days
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Hours of Work
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Rate of Pay
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General Description of Duties
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