WSC Intake and Assessment Form

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Client No (Office Use only)

Congratulations on coming to Working Skills Centre as your first step in getting closer to your training
settlement and career goals.
Please take your time and fill in this Intake and Assessment Form. The more information you can give, the
better we will be able to help you. All the information you give us will be kept PRIVATE and
CONFIDENTIAL. (Human Rights Exemption 113)

Enter Information in the grey fields below

Date: Monday, January 10, 2022

1. CONTACT INFORMATION

First Name: Dave-Damas

Middle Name or English Name: Dé

Last Name: Plancher

Home Phone: 4379958310

E-mail address: bookingavailable@gmail.com

Address: 808 MT Pleasant Apartment #:

City: Toronto Postal Code:

Closest Major intersection: Eglinton

Other contact Phone:

2. PERSONAL INFORMATION

Date of Birth: 25/03/1981

Year of arrival in Canada:

Gender: MAN

Immigration Status: Canadian Citizen

Country of Birth:

Current Income Support: OW

WSC also provides settlement and employment support. Please indicate if you would
like an appointment with a counsellor? Yes ☒ No ☐

What kind of work would you like to do in the future? Online office

Office Use Only: Program ☐☐☐☐

Comments (Job & Training Interest):

 Client Needs:
Academic Upgrading ☐ Not Identified ☐
Apprenticeship ☐ Shelter ☐
Career Planning ☐ Skills Training Accounting ☐
Crisis or Supportive Counseling ☐ Skills Training Administration ☐
ESL ☐ Skills Training Mailroom ☐
High School Diploma ☐ Skills Training Medical Administration ☐
Job Search Support ☐ Skills Training Modular ☐
Literacy ☐ Work Experience ☐

Needs Comment:

Referral to other Agency: ☐Yes ☐No

Name of Organization:

☐Literacy Class ☐Settlement Program

☐ESL Class ☐Job Finding Program
☐Counseling ☐Skills Training Program