Forms
Search result(s)
| Title and description | Release Date |
|---|---|
Declaration of income (6468A) (PDF, 525 KB)This form must be completed if you are participating in an employment assistance activity, but are not receiving government income support and are not an Employment Insurance participant. An Employment Insurance participant is a person who has received employment insurance benefits at any time in the past 60 months or has paid premiums to the Employment Insurance Program during 5 of the past 10 years. The form is used to verify whether your income in the past 12 months and that of your family, if any, is under the low-income cut-off. The information will allow the personnel at the Ministère to determine whether you are eligible for financial assistance during your participation in an employment assistance activity. Submit the duly completed, signed and dated form to your nearest Services Québec office. To find your local employment centre, use the Local Employment Centre Locator |
November 2019 |
Guide and form – Assessment of income and assets for self-employed worker (SR-0025A) (PDF, 1.4 MB)Form required by the local employment centre at the time of the application for last-resort financial assistance benefits or during a reassessment while receiving benefits. This form is intended to provide a statement of your income and expenses as well as an inventory of your assets as a self-employed worker. Submit the completed form in person or by mail to your local employment centre. By default, Acrobat prints documents in letter format. To print this form on legal size paper (8 1/2 X 14), adjust printing configuration. |
September 2019 |
Follow-up sheet for a referral or recuitement activity (6478-01A) (PDF, 341 KB)Follow-up sheet for a referral or recuitement activity to be completed by the outside partner. |
September 2019 |
Proof of residence (SR-2136A) (PDF, 114 KB)Form required by the local employment centre. This form is intended to provide confirmation, by your landlord or rooming-house keeper, of the information concerning your place of residence. |
September 2019 |
First application for last-resort financial assistance - Refugee protection claimants (3002A) (PDF, 305 KB)Complete this form if you are filing a first application for last-resort financial assistance and you, or you and your spouse, are claiming refugee protection. |
September 2019 |
Parental contribution (SR-2102A) (PDF, 163 KB)Form to be completed by parent(s). This form must be completed when a child who is considered a dependent of his or her parents files an application for financial assistance. |
July 2019 |
Medical report (SR-2100A) (PDF, 273 KB)This is not an official form. It is a guide to help physicians complete the “Rapport medical” (SR-2100) form, which is available in French only. The physician must complete the official French form in order for us to determine whether you have temporary or permanent functional limitations. |
July 2019 |
Qualification Program – Enrolment Application (01-1000) (PDF, 689 KB)This form is the enrolment application for the following programs:
This guide contains general information to help you complete the enrolment application: Information Guide (PDF, 587 KB) |
March 2019 |
Application for an Administrative Reconsideration (EQ-6505A) (PDF, 96 KB)Form that must be used to file an application for administrative reconsideration of a decision related to a program, measure or employment service. Used in cases where the decision is not subject to an application for review. |
February 2019 |
Certificat médical (French only) (SR-0040) (PDF, 266 KB)Form to be completed by a physician. Required to confirm a pregnancy or health condition that entitles the employment-assistance recipient to a special benefit. Submit the completed form in person or by mail to your local employment center. |
October 2018 |
