Forms
Search result(s)
| Title and description | Release Date |
|---|---|
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 |
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 |
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, 358 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 |
Declaration of income (6468A) (PDF, 99 KB)This form must be completed if you are not receiving public income support. It is required in order to determine whether your income is under the low-income cut-off and will allow the personnel at the Ministère to verify whether you are eligible for financial support in the form of an employment assistance allowance or amount for incidental expenses. Send the duly completed, signed and dated form to your local employment centre (CLE). To find your local employment centre, use the Local Employment Centre Locator |
January 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 |
Avis de placement ou de fin de placement d’un prestataire dans un établissement reconnu par le ministère de la Santé et des Services sociaux (French only) (SR- 0060) (PDF, 1.9 MB)Form to be completed by a person or organization in the health network that is recognized by the Ministère de la Santé et des Services sociaux (MSSS). Necessary to request the placement of a last-resort financial assistance recipient in an establishment recognized by the MSSS. Submit the completed form in person or by mail to the local employment centre responsible for the recipient’s file. By default, Acrobat prints documents in letter format. To print this form on legal size paper (8 1/2 X 14), adjust printing configuration. |
October 2018 |
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. |
October 2018 |
