Employer Release of Information Form

Choose your YMCA of Niagara Employment Services location: *

Client gives permission to the YMCA of Niagara Employment and Immigrant Services staff to provide and receive information, both verbally and/or written for the purpose of supporting training goals, gaining work experience and securing employment.

Communication with an employer is limited to: *

Providing work reference
Obtaining training placements, monitoring, and follow up
Enhancing job search skills through mock interviews and other employment related workshops
Forwarding resumes
Cold calling for job leads
All employers regarding job search
Only employers listed below, as per client:

Please specify employer(s): *

Is the participant over 16 years of age? *

Yes
No

By entering my name below, I acknowledge that my Service Provider has explained its use and disclosure of my personal information for its purpose.

Participant's name: *

First

Last

Participant's consent: *

I agree
I do not agree

Parent/guardian's name: *

First

Last

If participant is under 16 years of age

Parent/guardian's consent: *

I agree
I do not agree

If participant is under 16 years of age

Date: *

E-mail: *

This consent is valid for 1 year after program closure date.