Application Form | Level It Up

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Application Form

"*" indicates required fields

Name*

First Last

Address*

Street Address City

Email*

Phone*

Are you a Canadian citizen, and do you have a legal right to work in Canada?*

Yes

No

Are you eligible for Community Living disAbility Services?*

Yes

No

(a provincial government program assisting adults with intellectual disabilities)

How did you find out about Level IT Up?*

When were you diagnosed as autistic/on the autism spectrum?*

What is your understanding about your diagnosis?*

Can you use email, spell check, Microsoft Word and Excel, etc.?*

Yes

No

Do you have access to the Internet?*

Yes

No

If yes, are there any supervision concerns we should be aware of when you access the Internet?

Do you have any serious mental health concerns that could interfere with your success with Level IT Up or employment?*

Yes

No

If yes, please describe:

Have you been convicted of a felony?

Yes

No

If yes, please explain:

Tell us about your education:

Did you attend High School?*

Yes

No

If yes, where did you attend High School?

Name/Location: Number or Years Attended: Degree/Area of Study:

Did you graduate?

Yes

No

Did you attend College or University?*

Yes

No

If yes, where did you attend College/University?

Name/Location: Number or Years Attended: Degree/Area of Study:

Did you graduate?

Yes

No

Did you attend Graduate School?*

Yes

No

If yes, where did you attend Graduate School?

Name/Location: Number or Years Attended: Degree/Area of Study:

Did you graduate?

Yes

No

Did you attend any other form of school?*

Yes

No

If yes, where did you attend?

Name/Location: Number or Years Attended: Degree/Area of Study:

Did you graduate?

Yes

No

Tell us about your employment history:

Do you have previous work experience?*

Yes

No

Employer:

Employed From/To:

Start date: End date:

Position:

Duties:

Reason for Leaving:

Employer:

Employed From/To:

Start date: End date:

Position:

Duties:

Reason for Leaving:

Employer:

Position:

Employed From/To:

Start date: End date:

Duties:

Reason for Leaving:

About You

What are your hobbies/special interests?*

What experience do you have working on or with computers?*

What are your career aspirations?*

Do you have any behaviour that could interfere with social situations?*

Yes

No

If yes, please describe:

Can you write/type?*

Yes

No

If yes, please select your writing level:*

(check one box)

Single words

Sentances

Paragraph-length

Do you use these writing skills on a daily basis?*

Yes

No

Are you able to work independently on activities, including homework, with minimal supervision and stay on task for a set period of time?*

Yes

No

Can you tolerate a group learning environment?*

Yes

No

Are you able to sit through 3 hour training sessions (this includes breaks)?*

Yes

No

Can you focus on a task that may not be of interest, and complete simple tasks without prompting?*

Yes

No

Please explain:*

What else can you tell us about yourself to help us to get to know you better?*

What types of supports/assistance do you think you may require to work with us?*

Please use past experience from school or work. Be as honest and as open as possible about what types of supports you require.

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