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Complete each section in the form below. When you have finished, click on Create
eServices Profile button at the bottom of this page. *Required fields

* First Name:
* Last Name:
* User Name:
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Preferred Contact Method:	Select One --------------------------- Contact by Email Contact by Phone
* Email:
* Phone Number:
* Location:	Please Select A Location --------------------------- Ainsworth Argenta Balfour Boswell Crawford Bay Crescent Valley Gray Creek Harrop Kaslo Meadow Creek Mirror Lake Nelson Other Procter Queen’s Bay Riondel Salmo Slocan Slocan Park South Slocan Vallican Winlaw Ymir
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What KCDS Services are your interested in?
	Career Planning Career Exploration Cover Letters Assistance Education Options Funding for Training Interview Preparation Job Search Strategies Labour Market Information Resume Assistance Targeted Wage Subsidy Self Employment Finding Work in Nelson & Area Careers in the Trades Careers in Tourism Careers in Healthcare Job Banks Government Websites Local Community & Employment Agencies Search Resources Seasonal Work
* How did you find out about us?	Select One --------------------------- Service Canada (EI) Advertisement Website Word of Mouth Search Engine (Google) Other: (Please specify)
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Limited Confidentiality and Release of Information Agreement The employment counsellor's primary responsibility is to respect the integrity and promote the welfare of clients. The counselling relationship is CONFIDENTIAL within the limits of the law under the Freedom of Information and Protection of Privacy Act. I understand these exceptions: A. Potential Harm: If the behaviour of a client threatens potential harm to her/himself or another person, the employment counsellor must take reasonable personal action or information responsible authorities. B. Child Abuse: If there is reason to believe that a child is being physically or sexually abused or is in danger of being abused, the counsellor has a legal and ethical mandate to report this concern to responsible authorities. C. Consent: With the consent of the client, the employment counsellor may divulge information received during counselling. D. Legal Action: Employment counsellors do not have privileged information and must release counselling information if instructed to do so by the courts. E. Professional Consultation: With the consent of the client, an employment counsellor may consult with any other professionally competent person about the client. F. Results Reported: Notes may be taken and are kept on hard copy files. Registration and employment-related information reported is kept on computer data system. I authorize my employment counsellor to: Disclose/exchange my personal information on the following: 1. To confirm my eligibility for and participation in Employment Benefits and Support Measures Programs. 2. Information regarding my training, employment history, and Income Support. 3. Information regarding my progress and completion of my Return to Work Action Plan. The information disclosed/exchanged will be treated as confidential and will be used solely by: 1. KCDS to administer Employment Benefits and Support Measures Programs. 2. Service Canada to determine program eligibility. 3. Employment and Labour Market Services (Province of BC) to evaluate Employment Programs and to report on my Return to Work Action Plan and progress. 4. If required, Ministry of Housing and Social Development to report on my Return to Work Action Plan progress. 5. Agencies working with my case manager on employment-related progress. Upon completion of my Return to Work Action Plan, this authorization will automatically be cancelled.
Checking this box constitutes my signature authorizing my agreement to the Confidentiality and ROI with KCDS.
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