This form is designed to collect information that will help the IFOOD360° program coordinators understand who is enrolled in the program. We will use the information that you provide on this form to understand what types of assistance might be of most benefit for you, and to highlight specific skills and areas of potential interest for you.

Please answer all questions. If you don't understand a question or are not sure what to write, please let your coordinator know and he or she will be happy to help you.

***Information you provide on this form will be used for IFOOD360° program purposes only***

Employee Contact Information

Employer

First Name

Last Name

Street Number

Apt/Unit Number

Street Name

Town/City

Province

Postal Code

Best phone number to reach you?

How do you prefer to be contacted by the IFOOD360° Program?

Phone

Text

Other (please specify)

If you prefer to be contacted by phone, for reasons of confidentiality, can we can leave a message at the number you have provided?

Yes

Educational Experience

We are interested in understanding your educational experience.
Please fill out the following table with your highest level of educational experience.

School/Institution	Did you graduate?
Type
Grade School	Yes No
High School	Yes No
College	Yes No
University	Yes No
Other	Yes No

I don't have any educational experience to list

Program Name or Area of Study (Highest Level)

Country of Institution

Please list any other training or courses that you have taken:
* In this section you may list workplace training that you have received or participated in.

Course Name

Course Training Title

Location/Country

Add more

Have you ever taken an on-line course?

Yes

If yes, what online course(s)?

Add more

Work Experience and Future Goals

We are interested in understanding your current employment situation and any future employment goals.

What is your current job title?

What are your main tasks and responsibilities?

Add more

Previous work experience, job title?

What were your main tasks and responsibilities?

Add more

How long have you worked with your current employer?

Years

Months

How long have you worked in the food processing industry?

Years

Months

What other jobs or occupations with your current employer would you be interested in?

Add more

What areas of training or courses are you most interested in taking at this stage?

Add more

By clicking on the boxes below, you confirm you have read and agree to the terms below.

If I leave this program, I will be asked to provide the reason why and I understand this is for information purposes only and I will not be judged by my response.

I verify that I am the correct applicant as stated in all official registrations. I understand that FPSC reserves the right to revoke any certificates, passing marks, or completely remove an individual from the program if found cheating, copying material, or making false statements of identity.

Date: April 20, 2024

Employee Contact Information

Describing Yourself

Educational Experience

Work Experience and Future Goals