app.smartsheet.com
Open in
urlscan Pro
54.83.153.6
Public Scan
URL:
https://app.smartsheet.com/b/form/c71205b97a8642c4bac1ef87f5083094
Submission: On March 20 via api from CZ — Scanned from DE
Submission: On March 20 via api from CZ — Scanned from DE
Form analysis 1 forms found in the DOM
<form>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_undefined" data-client-type="heading" class="css-1e2fy0l e1vg1njp0">
<div class="css-336d07 e13qqj0j0"></div>
<p data-client-id="subheading_undefined" class="css-1ey0zoe e1vg1njp2"></p>
<p><strong>Information Privacy Act Agreement</strong></p>
<p><br></p>
<p>This information is administered with the Privacy Act (R.S.C., 1985, c. P-21) and the Department of Employment and Social Development Canada Act (S.C. 2005, c. 34) and the participant has a right under the Access to Information Act (R.S.C.,
1985, c. A-1) to obtain access to this information from Canada.</p>
<p></p>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_First Name (as it appears on SIN card)" data-client-type="text" id="YYb3emO" class="css-1e3khfm ef83ajd0"><label for="text_box_First Name (as it appears on SIN card)"
data-client-id="label_First Name (as it appears on SIN card)" class="css-1xl1v40 ekxsfat0">First Name (as it appears on SIN card)<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_First Name (as it appears on SIN card)" data-client-id="text_box_First Name (as it appears on SIN card)" data-client-type="" name="YYb3emO"
maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Last Name (as it appears on SIN card)" data-client-type="text" id="w5nKOl9" class="css-1e3khfm ef83ajd0"><label for="text_box_Last Name (as it appears on SIN card)"
data-client-id="label_Last Name (as it appears on SIN card)" class="css-1xl1v40 ekxsfat0">Last Name (as it appears on SIN card)<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Last Name (as it appears on SIN card)" data-client-id="text_box_Last Name (as it appears on SIN card)" data-client-type="" name="w5nKOl9"
maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Social Insurance Number" data-client-type="text" id="zpn0MOl" class="css-1e3khfm ef83ajd0"><label for="text_box_Social Insurance Number" data-client-id="label_Social Insurance Number"
class="css-1xl1v40 ekxsfat0">Social Insurance Number<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex; width: 193px;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Social Insurance Number" data-client-id="text_box_Social Insurance Number" data-client-type="NUMERIC" type="number" name="zpn0MOl"
maxlength="4000" class="css-1p0590h e1407lhe0" value="" style="width: 300px;"></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Date of Birth / Date de naissance" data-client-type="date" id="2zLa8Qk" class="css-gbq6lm ef83ajd0"><label for="date_Date of Birth / Date de naissance" data-client-id="label_Date of Birth / Date de naissance"
class="css-1xl1v40 ekxsfat0">Date of Birth / Date de naissance<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<p id="description_Date_of_Birth___Date_de_naissance" class="css-1jo9ly9 e5k3c9p0"></p>
<div class="css-1f92r3b"><input data-client-id="date_Date of Birth / Date de naissance" id="date_Date of Birth / Date de naissance" aria-label="Date of Birth / Date de naissance" tabindex="0" name="Date of Birth / Date de naissance"
maxlength="100" class="css-1dpiipj epidubd0" value=""><button tabindex="0" type="button" aria-label="Choose" class="css-17q24xo"><span title="Choose a date" class="css-14atay6 e1yrjtds0"><svg xmlns="http://www.w3.org/2000/svg" role="img"
width="16" height="16" viewBox="0 0 16 16">
<title>Calendar Icon</title>
<desc>Calendar</desc>
<g fill="none" fill-rule="evenodd">
<rect width="13" height="13" x="2" y="2" fill="#005EE0" rx="1"></rect>
<path fill="#FFF"
d="M11.648 12h-.96V8.38c-.351.328-.765.571-1.241.728v-.871c.25-.082.523-.238.817-.467.294-.229.495-.496.605-.801h.779V12zm-6.385-1.33l.93-.112c.03.237.11.418.24.543.129.125.286.188.47.188a.648.648 0 0 0 .502-.226c.135-.15.203-.353.203-.608 0-.241-.065-.433-.195-.574a.621.621 0 0 0-.475-.212c-.123 0-.27.024-.44.072l.105-.783c.26.007.458-.05.595-.17a.602.602 0 0 0 .205-.476.545.545 0 0 0-.15-.403.54.54 0 0 0-.4-.15.579.579 0 0 0-.42.17c-.117.114-.188.28-.213.5l-.885-.151c.061-.303.154-.545.279-.726.124-.182.297-.324.52-.428.221-.103.47-.155.746-.155.472 0 .85.15 1.135.45.234.247.352.525.352.835 0 .44-.24.79-.721 1.053.287.061.516.199.688.413a1.2 1.2 0 0 1 .258.776c0 .44-.16.815-.482 1.125-.32.31-.72.464-1.2.464-.453 0-.829-.13-1.127-.39a1.538 1.538 0 0 1-.52-1.025zM11 5a1 1 0 1 1 0-2 1 1 0 0 1 0 2zM6 5a1 1 0 1 1 0-2 1 1 0 0 1 0 2z">
</path>
</g>
</svg></span></button></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Job Title" data-client-type="text" id="OOlz5WlP" class="css-1e3khfm ef83ajd0"><label for="text_box_Job Title" data-client-id="label_Job Title" class="css-1xl1v40 ekxsfat0">Job Title<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Job Title" data-client-id="text_box_Job Title" data-client-type="" name="OOlz5WlP" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Email" data-client-type="text" id="pRnYvdq" class="css-1e3khfm ef83ajd0"><label for="text_box_Email" data-client-id="label_Email" class="css-1xl1v40 ekxsfat0">Email<span data-client-id="required_indicator"
class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_Email" data-client-id="text_box_Email" data-client-type="" name="pRnYvdq" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Phone number / Numéro de téléphone" data-client-type="text" id="QpXA2ww" class="css-1e3khfm ef83ajd0"><label for="text_box_Phone number / Numéro de téléphone"
data-client-id="label_Phone number / Numéro de téléphone" class="css-1xl1v40 ekxsfat0">Phone number / Numéro de téléphone<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;">
<div class=" react-tel-input" style="height: 35px; width: 40px;">
<div class="special-label">Phone</div><input class=" form-control" placeholder="1 (702) 123-4567" type="tel" name="QpXA2ww" aria-hidden="true" aria-label="phone picker" value="+1" style="display: none;">
<div class=" flag-dropdown">
<div class="selected-flag" title="United States: + 1" tabindex="0" role="button" aria-haspopup="listbox">
<div class="flag us">
<div class="arrow"></div>
</div>
</div>
</div>
</div><input aria-invalid="false" tabindex="0" id="text_box_Phone number / Numéro de téléphone" data-client-id="text_box_Phone number / Numéro de téléphone" data-client-type="PHONE" type="text" value="+1 (___) ___-____" inputmode="numeric">
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Citizenship Status / Statut de citoyenneté" data-client-type="dropdown" id="ZwDaM6q" class="css-u3yn36 ef83ajd0"><label for="select_input_Citizenship Status / Statut de citoyenneté"
id="d9132cc1-cfdd-4099-a49b-112f811a654d" data-client-id="label_Citizenship Status / Statut de citoyenneté" class="css-1xl1v40 ekxsfat0">Citizenship Status / Statut de citoyenneté<span data-client-id="required_indicator"
class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Citizenship Status / Statut de citoyenneté" spellcheck="false" tabindex="0" type="text"
aria-label="Select" aria-labelledby="d9132cc1-cfdd-4099-a49b-112f811a654d" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Gender / Genre" data-client-type="dropdown" id="J3XQWkQ" class="css-u3yn36 ef83ajd0"><label for="select_input_Gender / Genre" id="c653a851-abef-4633-96da-9256ae6a78f1"
data-client-id="label_Gender / Genre" class="css-1xl1v40 ekxsfat0">Gender / Genre<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select or enter value</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Gender / Genre" spellcheck="false" tabindex="0" type="text"
aria-label="Select or enter value" aria-labelledby="c653a851-abef-4633-96da-9256ae6a78f1" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Sexual Orientation / Orientation sexuelle" data-client-type="dropdown" id="yMyOQENY" class="css-u3yn36 ef83ajd0"><label for="select_input_Sexual Orientation / Orientation sexuelle"
id="56bda50e-6a27-4b0a-a0c1-bea62c2379cc" data-client-id="label_Sexual Orientation / Orientation sexuelle" class="css-1xl1v40 ekxsfat0">Sexual Orientation / Orientation sexuelle</label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Sexual Orientation / Orientation sexuelle" spellcheck="false" tabindex="0" type="text"
aria-label="Select" aria-labelledby="56bda50e-6a27-4b0a-a0c1-bea62c2379cc" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_If other, please type it in / Si autre, veuillez le saisir" data-client-type="text" id="36L8QRGm" class="css-1e3khfm ef83ajd0"><label for="text_box_If other, please type it in / Si autre, veuillez le saisir"
data-client-id="label_If other, please type it in / Si autre, veuillez le saisir" class="css-1xl1v40 ekxsfat0">If other, please type it in / Si autre, veuillez le saisir</label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="0" id="text_box_If other, please type it in / Si autre, veuillez le saisir" data-client-id="text_box_If other, please type it in / Si autre, veuillez le saisir"
data-client-type="" name="36L8QRGm" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Black Canadian / Noir canadien" data-client-type="dropdown" id="61KXZd9" class="css-u3yn36 ef83ajd0"><label for="select_input_Black Canadian / Noir canadien"
id="3a906ade-e2fd-44b8-b115-a2c775b6e33f" data-client-id="label_Black Canadian / Noir canadien" class="css-1xl1v40 ekxsfat0">Black Canadian / Noir canadien<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Black Canadian / Noir canadien" spellcheck="false" tabindex="0" type="text"
aria-label="Select" aria-labelledby="3a906ade-e2fd-44b8-b115-a2c775b6e33f" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Indigenous / Autochtone" data-client-type="dropdown" id="A9lAYvK" class="css-u3yn36 ef83ajd0"><label for="select_input_Indigenous / Autochtone" id="075815c2-89ba-43f8-8d0e-b21e03bd4a01"
data-client-id="label_Indigenous / Autochtone" class="css-1xl1v40 ekxsfat0">Indigenous / Autochtone<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select or enter value</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Indigenous / Autochtone" spellcheck="false" tabindex="0" type="text"
aria-label="Select or enter value" aria-labelledby="075815c2-89ba-43f8-8d0e-b21e03bd4a01" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Other racialized communities or visible minority" data-client-type="dropdown" id="32AkwyX" class="css-u3yn36 ef83ajd0"><label
for="select_input_Other racialized communities or visible minority" id="e37537f6-419a-4c7c-83b8-88938342c0d0" data-client-id="label_Other racialized communities or visible minority" class="css-1xl1v40 ekxsfat0">Other racialized communities or
visible minority<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="rich-text-field-desc css-1q4upac" id="description_select_input_Other_racialized_communities_or_visible_minority">
<p>South Asian, Chinese, Filipino, Latin American, Arab, Southeast Asian (Vietnamese/Cambodian/Laotian/Thai), West Asian (Iranian/Afghan), Korean, Japenese, Other</p>
</div>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Other racialized communities or visible minority" spellcheck="false" tabindex="0"
type="text" aria-label="Select" aria-labelledby="e37537f6-419a-4c7c-83b8-88938342c0d0" value="" aria-describedby="description_select_input_Other_racialized_communities_or_visible_minority"
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Person with disability(ies)" data-client-type="dropdown" id="GKXo6jA" class="css-u3yn36 ef83ajd0"><label for="select_input_Person with disability(ies)"
id="7da3ca2c-36d4-4426-86ed-b420925ad67d" data-client-id="label_Person with disability(ies)" class="css-1xl1v40 ekxsfat0">Person with disability(ies)<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Person with disability(ies)" spellcheck="false" tabindex="0" type="text"
aria-label="Select" aria-labelledby="7da3ca2c-36d4-4426-86ed-b420925ad67d" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Newcommer to Canada" data-client-type="dropdown" id="Rv7bW1v" class="css-u3yn36 ef83ajd0"><label for="select_input_Newcommer to Canada" id="0350b632-a112-4a2d-91b0-f3a02a56eef2"
data-client-id="label_Newcommer to Canada" class="css-1xl1v40 ekxsfat0">Newcommer to Canada<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="rich-text-field-desc css-1q4upac" id="description_select_input_Newcommer_to_Canada">
<p>0 to 5 years</p>
</div>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Newcommer to Canada" spellcheck="false" tabindex="0" type="text" aria-label="Select"
aria-labelledby="0350b632-a112-4a2d-91b0-f3a02a56eef2" value="" aria-describedby="description_select_input_Newcommer_to_Canada"
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Were you employed before this program?" data-client-type="dropdown" id="Rv7N0n1" class="css-u3yn36 ef83ajd0"><label for="select_input_Were you employed before this program?"
id="cfadd188-faaa-48fa-8567-06a6ea51439f" data-client-id="label_Were you employed before this program?" class="css-1xl1v40 ekxsfat0">Were you employed before this program?<span data-client-id="required_indicator"
class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Were you employed before this program?" spellcheck="false" tabindex="0" type="text"
aria-label="Select" aria-labelledby="cfadd188-faaa-48fa-8567-06a6ea51439f" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="container_Company name / Nom de l’entreprise" data-client-type="text" id="AOXnOjK" class="css-1e3khfm ef83ajd0"><label for="text_box_Company name / Nom de l’entreprise"
data-client-id="label_Company name / Nom de l’entreprise" class="css-1xl1v40 ekxsfat0">Company name / Nom de l’entreprise<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div id="description_Company_name___Nom_de_l_entreprise" class="rich-text-field-desc">
<p>This is the company that submitted your details for the subsidy program</p>
</div>
<div style="display: flex;"><input title="" aria-invalid="false" aria-describedby="description_Company_name___Nom_de_l_entreprise" tabindex="0" id="text_box_Company name / Nom de l’entreprise"
data-client-id="text_box_Company name / Nom de l’entreprise" data-client-type="" name="AOXnOjK" maxlength="4000" class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Province located" data-client-type="dropdown" id="GznoR6Nr" class="css-u3yn36 ef83ajd0"><label for="select_input_Province located" id="157ae111-5cc7-4f67-9090-8ea3c68b18c9"
data-client-id="label_Province located" class="css-1xl1v40 ekxsfat0">Province located<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Province located" spellcheck="false" tabindex="0" type="text" aria-label="Select"
aria-labelledby="157ae111-5cc7-4f67-9090-8ea3c68b18c9" value="" style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Enrolled in Driver Training or Employee?" data-client-type="dropdown" id="0q7nkyRj" class="css-u3yn36 ef83ajd0"><label for="select_input_Enrolled in Driver Training or Employee?"
id="b7f933b3-940a-45cb-be7b-6dd059692fb2" data-client-id="label_Enrolled in Driver Training or Employee?" class="css-1xl1v40 ekxsfat0">Enrolled in Driver Training or Employee?<span data-client-id="required_indicator"
class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Enrolled in Driver Training or Employee?" spellcheck="false" tabindex="0" type="text"
aria-label="Select" aria-labelledby="b7f933b3-940a-45cb-be7b-6dd059692fb2" value=""
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
</path>
</g>
</g>
</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Training start date" data-client-type="date" id="bMMra6Gl" class="css-gbq6lm ef83ajd0"><label for="date_Training start date" data-client-id="label_Training start date" class="css-1xl1v40 ekxsfat0">Training start
date<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<p id="description_Training_start_date" class="css-1jo9ly9 e5k3c9p0"></p>
<div class="css-1f92r3b"><input data-client-id="date_Training start date" id="date_Training start date" aria-label="Training start date" tabindex="-1" name="Training start date" maxlength="100" class="css-1dpiipj epidubd0" value=""><button
tabindex="-1" type="button" aria-label="Choose" class="css-17q24xo"><span title="Choose a date" class="css-14atay6 e1yrjtds0"><svg xmlns="http://www.w3.org/2000/svg" role="img" width="16" height="16" viewBox="0 0 16 16">
<title>Calendar Icon</title>
<desc>Calendar</desc>
<g fill="none" fill-rule="evenodd">
<rect width="13" height="13" x="2" y="2" fill="#005EE0" rx="1"></rect>
<path fill="#FFF"
d="M11.648 12h-.96V8.38c-.351.328-.765.571-1.241.728v-.871c.25-.082.523-.238.817-.467.294-.229.495-.496.605-.801h.779V12zm-6.385-1.33l.93-.112c.03.237.11.418.24.543.129.125.286.188.47.188a.648.648 0 0 0 .502-.226c.135-.15.203-.353.203-.608 0-.241-.065-.433-.195-.574a.621.621 0 0 0-.475-.212c-.123 0-.27.024-.44.072l.105-.783c.26.007.458-.05.595-.17a.602.602 0 0 0 .205-.476.545.545 0 0 0-.15-.403.54.54 0 0 0-.4-.15.579.579 0 0 0-.42.17c-.117.114-.188.28-.213.5l-.885-.151c.061-.303.154-.545.279-.726.124-.182.297-.324.52-.428.221-.103.47-.155.746-.155.472 0 .85.15 1.135.45.234.247.352.525.352.835 0 .44-.24.79-.721 1.053.287.061.516.199.688.413a1.2 1.2 0 0 1 .258.776c0 .44-.16.815-.482 1.125-.32.31-.72.464-1.2.464-.453 0-.829-.13-1.127-.39a1.538 1.538 0 0 1-.52-1.025zM11 5a1 1 0 1 1 0-2 1 1 0 0 1 0 2zM6 5a1 1 0 1 1 0-2 1 1 0 0 1 0 2z">
</path>
</g>
</svg></span></button></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Training End Date" data-client-type="date" id="QRRLQ8ZD" class="css-gbq6lm ef83ajd0"><label for="date_Training End Date" data-client-id="label_Training End Date" class="css-1xl1v40 ekxsfat0">Training End Date<span
data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<p id="description_Training_End_Date" class="css-1jo9ly9 e5k3c9p0"></p>
<div class="css-1f92r3b"><input data-client-id="date_Training End Date" id="date_Training End Date" aria-label="Training End Date" tabindex="-1" name="Training End Date" maxlength="100" class="css-1dpiipj epidubd0" value=""><button
tabindex="-1" type="button" aria-label="Choose" class="css-17q24xo"><span title="Choose a date" class="css-14atay6 e1yrjtds0"><svg xmlns="http://www.w3.org/2000/svg" role="img" width="16" height="16" viewBox="0 0 16 16">
<title>Calendar Icon</title>
<desc>Calendar</desc>
<g fill="none" fill-rule="evenodd">
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<path fill="#FFF"
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</div>
<div class="css-tkslta e1tmc1mx0">
<div role="application" title="" data-client-id="container_Do you demonstrate need for support for living and transportation expenses during this training?" data-client-type="dropdown" id="6ERbeqv" class="css-u3yn36 ef83ajd0"><label
for="select_input_Do you demonstrate need for support for living and transportation expenses during this training?" id="1bb456d7-8b62-49ff-b7b0-8785bd8457c9"
data-client-id="label_Do you demonstrate need for support for living and transportation expenses during this training?" class="css-1xl1v40 ekxsfat0">Do you demonstrate need for support for living and transportation expenses during this
training?<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off"
id="select_input_Do you demonstrate need for support for living and transportation expenses during this training?" spellcheck="false" tabindex="-1" type="text" aria-label="Select"
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<div
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</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
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<g fill="#161616">
<path
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</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Driver Training Institution name" data-client-type="text" id="rmZzgEv" class="css-1e3khfm ef83ajd0"><label for="text_box_Driver Training Institution name" data-client-id="label_Driver Training Institution name"
class="css-1xl1v40 ekxsfat0">Driver Training Institution name<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Driver Training Institution name" data-client-id="text_box_Driver Training Institution name" data-client-type="" name="rmZzgEv" maxlength="4000"
class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Institution address" data-client-type="text" id="EWQ3ANY" class="css-1e3khfm ef83ajd0"><label for="text_box_Institution address" data-client-id="label_Institution address" class="css-1xl1v40 ekxsfat0">Institution
address<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Institution address" data-client-id="text_box_Institution address" data-client-type="" name="EWQ3ANY" maxlength="4000" class="css-1p0590h e1407lhe0"
value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Institution contact person" data-client-type="text" id="bRlY6r6" class="css-1e3khfm ef83ajd0"><label for="text_box_Institution contact person" data-client-id="label_Institution contact person"
class="css-1xl1v40 ekxsfat0">Institution contact person<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Institution contact person" data-client-id="text_box_Institution contact person" data-client-type="" name="bRlY6r6" maxlength="4000"
class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Institution email address" data-client-type="text" id="3NnvrGL" class="css-1e3khfm ef83ajd0"><label for="text_box_Institution email address" data-client-id="label_Institution email address"
class="css-1xl1v40 ekxsfat0">Institution email address<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Institution email address" data-client-id="text_box_Institution email address" data-client-type="" name="3NnvrGL" maxlength="4000"
class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Institution Phone number" data-client-type="text" id="8Rnpqv1" class="css-1e3khfm ef83ajd0"><label for="text_box_Institution Phone number" data-client-id="label_Institution Phone number"
class="css-1xl1v40 ekxsfat0">Institution Phone number<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div style="display: flex;"><input title="" aria-invalid="false" tabindex="-1" id="text_box_Institution Phone number" data-client-id="text_box_Institution Phone number" data-client-type="" name="8Rnpqv1" maxlength="4000"
class="css-1p0590h e1407lhe0" value=""></div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div role="application" title="" data-client-id="container_Consent" data-client-type="dropdown" id="k9L7yX3" class="css-u3yn36 ef83ajd0"><label for="select_input_Consent" id="f08472fa-f35d-4667-839b-23f8c763d87f" data-client-id="label_Consent"
class="css-1xl1v40 ekxsfat0">Consent<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="rich-text-field-desc css-1q4upac" id="description_select_input_Consent">
<p>I consent to the collection, uses and disclosure of the information provided in this form to Canada (the Government of Canada), and I attest that all the information I have provided is correct.</p>
<p><br></p>
<p>I agree to participate in Trucking HR Canada's Career ExpressWay Program as funded in part by the Government of Canada. </p>
</div>
<div class="css-t8xanh-container">
<div class="css-kf2egt-control react-select__control">
<div class="css-11ksah1 react-select__value-container">
<div class="css-1i5h0xy-placeholder react-select__placeholder">Select</div>
<div class="css-1g6gooi">
<div class="react-select__input" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="select_input_Consent" spellcheck="false" tabindex="0" type="text" aria-label="Select"
aria-labelledby="f08472fa-f35d-4667-839b-23f8c763d87f" value="" aria-describedby="description_select_input_Consent"
style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
<div
style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 13px; font-family: Arial; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
</div>
</div>
</div>
</div>
<div class="css-1wy0on6 react-select__indicators"><span class="css-9lpq22-indicatorSeparator react-select__indicator-separator"></span><span style="margin-right: 6px;"><svg data-client-id="caret_icon" width="16px" height="16px"
viewBox="0 0 16 16" version="1.1" role="img" xmlns="http://www.w3.org/2000/svg">
<title>Caret Icon</title>
<desc>Caret symbol</desc>
<g stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
<g fill="#161616">
<path
d="M8.38951287,9.81740951 C8.3743818,9.83527284 8.35811596,9.85207547 8.34082332,9.86770589 C8.12569934,10.0621513 7.79871352,10.0396329 7.61048004,9.81740951 L5.12806062,6.88673235 C5.04550447,6.78926879 5,6.66416424 5,6.53465776 C5,6.23937443 5.23172713,6 5.51757703,6 L10.4824159,6 C10.607785,6 10.7288928,6.04700617 10.8232427,6.13228679 C11.0383667,6.32673222 11.0601658,6.664509 10.8719323,6.88673235 L8.38951287,9.81740951 Z">
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</svg></span></div>
</div>
</div>
</div>
</div>
<div class="css-tkslta e1tmc1mx0">
<div data-client-id="container_Driver Agreement Form" data-client-type="file_upload" id="ATTACHMENT" class="css-1ylo82b ef83ajd0"><label for="file_upload_Driver Agreement Form" data-client-id="label_Driver Agreement Form"
class="css-1xl1v40 ekxsfat0">Driver Agreement Form<span data-client-id="required_indicator" class="css-skcghl ekxsfat1">*</span></label>
<div class="css-vqlje4" tabindex="-1" data-client-id="file_upload_dropzone" aria-disabled="false" style="position: relative;">
<div class="css-hvudvc eo18oon8"><span class="css-1btvv3a eo18oon1"><span>Drag and drop files here or </span> <button tabindex="-1" type="button" class="css-uro7iq eo18oon0"><span>browse files</span></button></span></div><input
id="file_upload_Driver Agreement Form" tabindex="-1" type="file" multiple="" autocomplete="off" style="position: absolute; inset: 0px; opacity: 1e-05; pointer-events: none;">
</div>
</div>
</div>
<div class="css-1o5h39n e1tmc1mx0">
<div data-client-id="email_receipt_section">
<div data-client-id="container_email_receipt" data-client-type="divider" class="css-1e2fy0l e14sboee0">
<hr data-client-id="email_receipt" class="css-1xs1ymt e14sboee2">
</div>
<div class="css-1gl0c9l excyp8g0"><label class="css-1y93uaa excyp8g1"><input data-client-id="email_receipt_checkbox" name="EMAIL_RECEIPT_CHECKBOX" type="checkbox" class="css-1czgm8r excyp8g2" value="false"><span>Send me a copy of my
responses</span></label></div>
</div>
</div>
<div class="css-1ock8o4 e1xpzprc2"><button data-client-id="form_submit_btn" disabled="" type="submit" value="submit" class="css-oltpmt e1xpzprc0"><span>Submit</span></button></div>
<div data-client-id="footer" class="css-ybae4b e8i4qwl0">
<div class="css-1kw6mnl e8i4qwl1"><a target="_blank" href="https://www.smartsheet.com/legal/privacy" rel="noopener noreferrer" data-client-id="footer_privacy" class="css-a7ff3e e8i4qwl2"><span>Privacy Notice</span></a><span
style="margin: 0px 5px;">|</span><a target="_blank" href="https://app.smartsheet.com/b/reportabuse?EQBCT=c71205b97a8642c4bac1ef87f5083094" rel="noopener noreferrer" data-client-id="footer_reportAbuse" class="css-a7ff3e e8i4qwl2"><span>Report Abuse</span></a>
</div>
</div>
</form>Text Content
SWSP Participant Information Form Information Privacy Act Agreement This information is administered with the Privacy Act (R.S.C., 1985, c. P-21) and the Department of Employment and Social Development Canada Act (S.C. 2005, c. 34) and the participant has a right under the Access to Information Act (R.S.C., 1985, c. A-1) to obtain access to this information from Canada. First Name (as it appears on SIN card)* Last Name (as it appears on SIN card)* Social Insurance Number* Date of Birth / Date de naissance* Calendar IconCalendar Job Title* Email* Phone number / Numéro de téléphone* Phone Citizenship Status / Statut de citoyenneté* Select Caret IconCaret symbol Gender / Genre* Select or enter value Caret IconCaret symbol Sexual Orientation / Orientation sexuelle Select Caret IconCaret symbol If other, please type it in / Si autre, veuillez le saisir Black Canadian / Noir canadien* Select Caret IconCaret symbol Indigenous / Autochtone* Select or enter value Caret IconCaret symbol Other racialized communities or visible minority* South Asian, Chinese, Filipino, Latin American, Arab, Southeast Asian (Vietnamese/Cambodian/Laotian/Thai), West Asian (Iranian/Afghan), Korean, Japenese, Other Select Caret IconCaret symbol Person with disability(ies)* Select Caret IconCaret symbol Newcommer to Canada* 0 to 5 years Select Caret IconCaret symbol Were you employed before this program?* Select Caret IconCaret symbol Company name / Nom de l’entreprise* This is the company that submitted your details for the subsidy program Province located* Select Caret IconCaret symbol Enrolled in Driver Training or Employee?* Select Caret IconCaret symbol Training start date* Calendar IconCalendar Training End Date* Calendar IconCalendar Do you demonstrate need for support for living and transportation expenses during this training?* Select Caret IconCaret symbol Driver Training Institution name* Institution address* Institution contact person* Institution email address* Institution Phone number* Consent* I consent to the collection, uses and disclosure of the information provided in this form to Canada (the Government of Canada), and I attest that all the information I have provided is correct. I agree to participate in Trucking HR Canada's Career ExpressWay Program as funded in part by the Government of Canada. Select Caret IconCaret symbol Driver Agreement Form* Drag and drop files here or browse files -------------------------------------------------------------------------------- Send me a copy of my responses Submit Privacy Notice|Report Abuse