Services for Employees & Job Seekers

Employment Services Referral Form

Making a Client Referral

If you are working with a client and would like to make a referral to Community Employment Services on behalf of that client, then you can complete the following form to begin the referral process.

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Client Contact Information

Does you have a SIN number?
Do you have a bank account?
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Referral Information

Self Referral
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Consent for Release of Information

In an effort to coordinate services, I hereby authorize the above-named service provider organizations to share and/or release any applicable information pertaining to my participation in services.

I acknowledge that the referring service provider may be notified once I have made contact with the referred service organization. I understand that I may, in writing, change or cancel this authorization at any time, except for such action as has already been taken.

As it pertains to Referrals from Ontario Works, MFIPPA applies:

I acknowledge that my personal information may be shared with various program participants as contemplated by s.14(1)(a) of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, CHAPTER m.56; I understand that the treatment, storage and handling of my personal information is governed by the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, CHAPTER m.56

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Contact Us

Community Employment Services

519-882-4333

Text: 519-312-3189

Fax: 1-888-865-2732

4248 Oil Heritage Road

Petrolia, ON