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Child Care Subsidy Work Search Record

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Child Care Subsidy Work Search Record Powered By Docstoc
					                                                                                                                                                ChIlD CarE SUBSIDY
                                                                                                                                              wOrk SEarCh rECOrD

 The personal information collected on this form is collected under the authority of the Child Care Subsidy Act and the Freedom of Information and Protection of Privacy Act for the purpose of administering
 the Child Care Subsidy Act. The Freedom of Information and Protection of Privacy Act protects the personal information collected from unauthorized use and disclosure. if you have any questions about the
 collection, use or disclosure of this information, please call the child care Subsidy Service centre at 1 888 338-6622 or inquire in writing to the address noted below.

This form is to be used by applicants (or their spouses) who are looking for work and requesting child care Subsidy. it must be returned to the child care
Subsidy Service centre. The information you provide will be used to determine further eligibility for child care Subsidy. use blue or black ink and print clearly.

SECTION 1                   applICaNT INfOrmaTION (please print)                                                                  DS number (office uSe only)
                            Please complete all applicable fields


 APPlicAnT’S nAme (last, first and middle)                                                                     SociAl inSurAnce number                         PHone
                                                                                                                                                               (        )
 ADDreSS                                                                                                       ciTy/ToWn                                       PoSTAl coDe



SECTION 2          ExamplES Of wOrk SEarCh aCTIvITIES
  Preparation of resume and/or cover letters                       Telephone inquiries to potential and specific employers
  Fact finding interviews                                          responding to newspaper ads, internet postings
  Submitting applications, letters and/or resumes for employment   Participating in employment interviews
  Attending workshops for resume preparation or employment search  calling potential employers
  networking with previous employers, friends, relatives or other
         business contacts
SECTION 3                   wOrk SEArCh rECOrd FOr:
                                                                                                                          nAme (last, first and middle)
Instructions: list the date, type of activity (e.g. resume preparation, personal interview, leaving applications with employers etc.), time
                       spent on that specific activity, business/contact name, phone number and result. Another page has been provided for
                       additional information, photocopy additional pages if needed.
    DATe of                                                    Time (HrS)
                            TyPe of AcTiViTy                                               buSineSS/conTAcT nAme                                  PHone number                reSulT of AcTiViTy
    AcTiViTy                                                     SPenT

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SECTION 4                   DEClaraTION
I confirm that: the information provided on this form and any additional pages is complete and accurate. i understand that i am required to immediately sup-
ply information to the child care Subsidy Service centre if there is a change to any information provided here or any subsequently provided information. This
record accurately reflects my work search efforts. I understand this information will be used to determine further eligibility.
 SiGnATure of PerSon SeekinG emPloymenT                                                                                                                        DATe SiGneD (yyyy/mmm/dd)



                                        Once completed, please fax or mail all pages to the Child Care Subsidy Service Centre
                                    Toll Free Fax 1-877-544-0699                                    Mailing Address
                                                                                            child care Subsidy Service centre
                                                                                               Po box 9953 Stn Prov Govt
                                                                                                   Victoria bc V8W 9r3
cf2910_(09/02)                               For more information on Child Care Subsidy, please call toll free: 1 888 338-6622
AddITIONAl wOrk SEArCh rECOrd FOr:
                                                                       nAme (last, first and middle)

 APPlicAnT’S nAme (last, first and middle)                                                             SociAl inSurAnce number




   DATe of                                   Time (HrS)
                    TyPe of AcTiViTy                      buSineSS/conTAcT nAme                PHone number    reSulT of AcTiViTy
   AcTiViTy                                    SPenT

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cf2910_(09/02)

				
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