Employment Discovery Tool

Employment Discovery Tool

The Community Living disABILITY Services (CLDS) invites you to answer the following questions. Your responses will tell us about your interest in working and may be used by your community service worker for planning employment or other support services.

The meanings for some of the terms used on this form can be found on the Definition of Terms page.

Privacy statement: Any information provided to CLDS is handled with utmost confidentiality and is managed and held in accordance with the The Freedom of Information and Protection of Privacy Act (FIPPA) and The Personal Health Information Act (PHIA).

Individual's Name*

Please provide first name and last name.

Date of Birth*

Please enter Year-Month-Date

Home Address*

Phone number

If applicable, name of the person helping you to fill out this form.

Relationship of this person to you (if applicable)

Select or enter value

Please specify 'other' relationship.

Name of agency:

Name of Community Service Worker (CSW)

Employment

Have you talked to anyone about working, volunteering or job readiness training?*

Select

Who did you talk to about working, volunteering or job readiness training? Select all that apply.

Select or enter value

If you selected 'Others', please specify who this person is; example: neighbour, store worker.

Are you interested in any of the following options? Select all that apply.*

Select or enter value

Do you have a resume?*

Select

Have you been to a job interview?*

Select

Do you need help to get a job (or new job)?*

Select

Do you want to learn about different types of jobs?*

Select

What kind of jobs interest you?

Examples: grocery store clerk, cashier, retail store worker, barista (makes coffee), babysitter, fast food worker, food server, cleaner

What kind of jobs do not interest you?

Examples: grocery store clerk, cashier, retail store worker, barista (makes coffee), babysitter, fast food worker, food server, cleaner

Which statement(s) describes your situation at this time? Select all that apply.*

Select or enter value

'Other' situation - please specify

How many hours per week do you work?

Select

Please specify your number of hours.

Are you happy with the number of hours you are working?

Select or enter value

Explain why you are not happy.

How long have you been working at your current job?

Select

Do you receive supports from a supported employment agency?

Select

What is the name of the agency?

Are you happy with the kind of relationships or connections you have with people at your current job?

Select

Explain why you are not happy.

Are you happy with your pay and benefits?

Select

Explain why you are not happy.

Do you want to try something new at your current job?

Select

What do you want to try and learn?

Volunteering

Have you volunteered before?*

Select

Where did you volunteer?

Are you interested in learning about volunteer opportunities?*

Select

What kind(s) of volunteer opportunities are you interested in learning about?

Examples: helping in an animal shelter, helping in a soup kitchen, helping in an elderly home

Are you currently volunteering?*

Select

Where do you volunteer?

What type of volunteer activities do you do?

Are you happy with your volunteer activities?

Select

Explain why you are not happy.

Job Readiness Training

Have you had job readiness training before?*

Select

Where did you take your job readiness training?

Are you interested in exploring job readiness training as an opportunity to develop or expand your skills?*

Select

Are you currently attending job readiness training?*

Select

Where are you attending job readiness training? What is the name of your training program?

Are you happy with the job training program you are attending?

Select

Explain why you are not happy with your current job training.

Would you like to look for another job training opportunity?

Select or enter value

What type of job training opportunity would you like?

Challenges

What challenges do you experience (or think you might experience) with working, volunteering or job readiness training? Select all that apply.*

Select or enter value

Please identify what services are lacking.

Please identify specific mental health challenges.

Examples - anxiety, depression, trauma, eating disorder, phobia, etc.

Please identify specific physical health challenges.

Examples - epilepsy, obesity, poor eyesight, hearing loss, others

Please identify specific accessibility issues.

Examples – lack of interpreters for American Sign Language, lack of wheelchair access in buildings, others

Please specify other challenges you experience (or think you might experience).

If you could get help with these challenges, would you be interested in working, volunteering or attending a job readiness program?

Select

Thank you for completing the form.

Your information will be reviewed by department staff and your community service worker may reach out to you to request further details or to provide information.

FIPPA and PHIA Statement

The Manitoba government is authorized to collect personal information and personal health information under clause 36(1)(b) of The Freedom of Information and Protection of Privacy Act (“FIPPA”) and section 13(1) of The Personal Health Information Act (“PHIA”), respectively.

The information being collected is protected by the privacy provisions under FIPPA and PHIA. The Manitoba government cannot use or disclose the collected personal or personal health information for any other purpose, unless authorized or required to do so under FIPPA or PHIA.

For more information about the collection and use of this information, contact your community service worker.

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