EXPORT Database | Centre of Excellence

Personal Information

First Name

Last Name

Date of Birth

Gender
Male Female

Mailing Address

Address

City

Province

Postal Code

Home Address

If your home address is the same as your mailing address, check this box.

Address

City

Province

Postal Code

Contact Information

Email Address

Telephone #1

Telephone #2

If you do not have an email address, register for a free one through Google's Gmail service, and then use that email address to complete this form.

Education

Primary & High School

What is your highest level of primary/high school education?

If you have Grade 12, was this obtained through Adult Basic Education, GED or other alternate means? Yes No

Post Secondary

List any certificate or diploma courses you have completed.

Course:

School:

Completed:

Employment

Employment Status

Drivers License

Do you have a driver's license? Yes No

If yes, what class?

Note: A standard drivers' license is Class 5; learners' license is Class 7; all of classes require additional testing.

Workforce Self-Identification

This information is used for statistical purposes only.

Self Identification

Do you live on a reserve? Yes No

Eligibility - Athabasca Basin Residents

To be eligible, applicants must qualify under one of the following categories:

A registered member or permanent resident of Black Lake Denesųłiné First Nation, Fond Du Lac Denesųłiné First Nation or Hatchet Lake Denesųłiné First Nation;
Individuals that maintain their primary residence in one of the Athabasca Basin Communities of Camsell Portage, Uranium City, Wollaston Lake or Stony Rapids;
Individuals that have principally resided in one of the Athabasca Basin Communities for not less than ten years;
Individuals that are current residents of a community as officially confirmed by a letter signed by the elected leader(s) of that community or as approved by the community's Scholarship Committee member; or,
Individuals who are dependent on a permanent long-term resident as defined above.

I am an Athabasca Basin Resident? Yes No I currently reside in the Athabasca Basin? Yes No

Account Information

Upon completing this form an account will be automatically generated for you. The email address you supply on this for will act as your username. If you would like to set a password now enter it below - otherwise one will be generated for you and included in your account activation email.

Please note Passwords are case sensitive and can include special characters.

Username

Your username will be set to the email address entered above.

Set your Password

Confirm your Password

Declaration

By completing this form, I understand that:

The information I have provided is true and accurate;

Yes No

This information will be used by EXPORT to assist applicants in finding employment and identify training opportunities for its members; and

Yes No

This information may be shared with my community and companies interested in partnering with First Nations in employment and training initiatives.

Yes No

Skills Inventory Form v1.0

Personal Information

Mailing Address

Home Address

Contact Information

Education

Primary & High School

Post Secondary

Employment

Drivers License

Workforce Self-Identification

Eligibility - Athabasca Basin Residents

Account Information

Declaration

Electronic Signature