Notes

Your application for assistance has been submitted. Please record your Application number for future reference.
Your Application number is: 558833-20160825 Please record this number for future reference.
Note: This is different than your Assessment number. We will need your Application number to find your Application information.
Save time by going online! While your application is being processed, you can begin setting up a My Self Serve account to get convenient access to a variety of ministry services online. Get started today
There are a number of documents you will need to provide for your eligibility interview.
Legal Name Change Document
Identification Documents
If you are not currently looking for work, verification of the reason why.
Verification of your past financial independence.
You are required to read all of the following information before clicking 'I Agree'.

DECLARATION: I declare that all the information I have provided is true and complete. I understand the accuracy of the information I provide will be checked by comparing it against information held by other governments, public bodies, private agencies and individuals. The BC government may verify and obtain information to confirm my eligibility or the eligibility of my dependents. I have read and understand the work search guidelines, BC Government's Responsibilities, My Rights, and My Responsibilities. I give permission to the organizations listed above to release information relevant to my eligibility or the eligibility of my dependents for assistance to employees of the ministry.

FREEDOM OF INFORMATION:
The personal information requested on this form is collected under the authority of and will be used for the purpose of administering the Employment and Assistance Act and the Employment and Assistance for Persons with Disabilities Act. The collection, use and disclosure of personal information is subject to the provisions of the Freedom of Information and Protection of Privacy Act. Any questions about this information should be directed to your local Employment and Income Assistance Office.

SEARCH FOR EMPLOYMENT:
Unless exempt, it is a condition of eligibility for income or disability assistance that you complete a search for employment satisfactory to the minister either by:

completing a search for employment as directed by the minister during the period immediately following the date you sign this form, or
demonstrating to the minister that a satisfactory search for employment has been completed during the period immediately prior to the date you sign this form.
You must use the Work Search Activities Record (HSD0077) and return it at the time of your appointment to complete the application process.

These conditions do not apply to applicants who meet one of the exemption criteria.

You are exempt from the condition to conduct a search for employment if you:

are a person fleeing an abusive spouse or relative,
are a person with a physical or mental condition that, in the minister's opinion, precludes you from completing a search for employment,
or any person in your family unit is a person with disabilities (PWD) as designated by the minister,
are prohibited by law from working in Canada,
have reached 65 years of age,
are a sole applicant with a dependent child if the child has not reached 3 years of age, or
are a sole applicant providing care to a child in the home of a relative, a foster child or a child in your care under an agreement referred to in sections 8 or 93 (1) (g) (ii) of the Child, Family and Community Service Act if the child has not reached 3 years of age.
BC GOVERNMENT'S RESPONSIBILITIES:
The BC government is responsible for making sure assistance goes only to people who are eligible. For this reason, the BC government must check and make sure people who have applied for or are receiving assistance are eligible. Information provided may be disclosed to other agencies only for this purpose.

The BC government must abide by the Freedom of Information and Protection of Privacy Act in the collection, use and disclosure of any personal information.

PRIVACY:
The collection, use and disclosure of this information are authorized under the Employment and Assistance and Employment and Assistance for Persons with Disabilities Acts and are permitted under the Freedom of Information and Protection of Privacy Act.
The Freedom of Information and Privacy Act has rules about:

how personal information is collected, stored and secured;
how to access personal information and how to ask for corrections;
limits on how personal information is used; and
limits on the disclosure of personal information.
MY RIGHTS
I have the right to the protection of my personal information, as well as the right to know what personal information the BC government has collected about me, as described in the Freedom of Information and Protection of Privacy Act.

I can receive more information about the collection, use and disclosure of my personal information by contacting my local Employment and Income Assistance Office.

I may appeal most decisions involving me that result in a refusal to provide a form of assistance or in the reduction or discontinuance of income assistance, disability assistance or a supplement.

I also have the right to make a complaint if I believe my personal information is not being collected, used or disclosed appropriately.

I will continue to receive assistance only as long as I continue to be eligible.

MY RESPONSIBILITIES

It is necessary for me to sign this form if I want to continue with the application process and receive assistance.

It is my responsibility to conduct a search for employment as directed by the minister.

It is my responsibility to provide accurate and complete information when I apply for and continue to receive assistance.

I must report all money and assets that I receive each month.

I must make every effort to pursue income or assets from other sources such as pensions, Employment Insurance, Family Maintenance, matrimonial settlements, etc. before receiving assistance from the BC government.

I must report all changes in my circumstances that might affect my eligibility for assistance. I will also report to the Ministry of Social Development any changes to the circumstances of my dependents that might affect eligibility.

I must enter into an employment plan when required to do so by the minister.

NOTIFICATION: Any person(s) having information or documents relevant to my eligibility for assistance may release them to employees of the ministry. Examples may include:

Human Resources and Social Development Canada (Old Age Security, Employment Insurance, Employment and Training programs and Canada Pension Plan);
BC Student Assistance Program;
Citizenship and Immigration Canada;
Other federal, provincial and municipal departments;
BC Online information such as: BC Assessment, Land Titles, Registrar of Companies;
Employers (to verify income); and
Landlords (to verify an address and amount of rent).
CONSENTS: The following organizations require your written permission before they will provide verification of your personal information:

Workers' Compensation Board (WCB);
Any financial institution, such as: banks, credit unions and trust companies;
Vital Statistics Agency (Birth Registrations, Birth, Marriage and Death Certificates);
Indian and Northern Affairs Canada (INAC);
Insurance Corporation of British Columbia;
Canada Revenue Agency (you will be required to sign a separate Canada Revenue Agency consent form during your eligibility interview);
Cheque cashing services; and
Credit Bureaus; and
Ministry of Public Safety and Solicitor General (PSSG) and Royal Canadian Mounted Police (RCMP) to verify outstanding warrant(s) for your arrest issued under the Immigration and Refugee Protection Act (Canada) or any other enactment of Canada in relation to an offence for which a person may be prosecuted by indictment.