Request to participate! PARTICIPATION FORM Please complete the following form to submit your request to participate. We will contact you as soon as we receive your form to brief you about the next steps. Step 1 of 3 33% SECTION A: GENERAL INFORMATIONBusiness / Organization Name:*Mailing Address (i.e head office):* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Physical Address (i.e. production sites) (if different from mailing address):* Same as Mailing Addresss Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Website SECTION B: TYPE OF ORGANIZATIONPlease identify your organization type?*Private businessNot for profit organizationGovernment serviceSection C: BUSINESS PROFILEIs your business a manufacturing industry company ?*YesNoYour Manufacturing Industry sub-sector:*311 - Food manufacturing312 - Beverage and tobacco product manufacturing313 - Textile mills314 - Textile product mills315 - Clothing manufacturing316 - Leather and allied product manufacturing321 - Wood product manufacturing322 - Paper manufacturing323 - Printing and related support activities324 - Petroleum and coal product manufacturing325 - Chemical manufacturing326 - Plastics and rubber products manufacturing327 - Non-metallic mineral product manufacturing331 - Primary metal manufacturing332 - Fabricated metal product manufacturing333 - Machinery manufacturing334 - Computer and electronic product manufacturing335 - Electrical equipment, appliance and component manufacturing336 - Transportation equipment manufacturing337 - Furniture and related product manufacturing339 - Miscellaneous manufacturingIf NO, what is the industry sector of your company ? (Please describe …)*Total number of frontline workers:*Total number of men frontline workers:*Total number of women frontline workers:*Total number of other gender frontline workers:*Total number of indigenous frontline workers:*Total number of newcomer frontline workers:*During the past 12 months, how many work-related training days were offered to frontline (production) workers (on average, PER worker)?* None Less than 1 day 1 to 2 days 3 to 5 days More than 5 days Do not know Language spoken in the workplace:* English French Both Other Please specify:What year did your business begin operating?*Section C: ORGANIZATION PROFILEWhat is the activity sector of your organization? (Notch all that apply)* Employability service Adult training service Other (Please describe) Activity Sector*Total number of clients*Total number of clients per genderMen*Women*Other genders*Total number of indigenous clients*Total number of newcomers (Permanent Residents/Refugees)* SECTION D: COMMITMENTTo be accepted as participant in the pilot testing of the Skills in Action online upskilling portal, an organization must commit to implement various project activities during the piloting phase. Please check each of the following statements to signify your organization’s acceptance of these conditions:* Provide an adequate training environment to learners (i.e. Time scheduled for training, training space, Internet connection). Be available for training activities during the pilot testing period (with flexible timelines tailored to your workers/workplace). Assign a minimum of 10 production workers to participate in the training activities. Offer a minimum of 20 hours of training per worker / learner (if needed). Select 1 or 2 workers to be trained as “Coaches” who would then provide support to workers participating in the training (12 hours of training will be provided to each “Coach”). Complete pre and post-training surveys and provide feedback on the training. If you estimate more than 10 workers / learners will participate, how many do you estimate will participate?Name:* First Last Job title:*Phone:*Cell:Fax:Email:* Email Confirm Email Any questions? Need more information? info@competencesenaction.ca Tel: (506)753-3344 Toll-Free: 1-888-351-3344PhoneThis field is for validation purposes and should be left unchanged.