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Special Projects Program Application for Employers

The Special Projects Program is designed to assist in the creation of innovative employment and training opportunities for employment disadvantaged Islanders.

Eligible employers are non-profit organizations in PEI and municipal governments incorporated in PEI, including their sponsored agencies.

Eligible employees are persons at least 30 years of age who have or are about to exhaust their Employment Insurance benefits.

Please read the guidelines before completing this application.

Fields marked with a red star (*) are mandatory.

Part 1 - Applicant Information


Organization Name: *
Mailing Address: *
Civic Address: *
Postal Code: *
X9X 9X9
Telephone: *
(555) 555-5555
Fax:
(555) 555-5555
Revenue Canada Taxation Business Number: *
Business Name Registry #:
Workers Compensation Firm Number: *
Contact Information


Primary Contact Name: *
Telephone: *
(555) 555-5555
Email:
Alternate Contact Name:
Telephone:
(555) 555-5555
Email:
Part II Project Description


Project Name: *
State the name of your project? (40 chars max)
Objectives or Results


State the objective(s) or anticipated results of your proposal.
Objectives: *
Activities


Outline the activities planned to meet the objective(s).
Activities: *
When will your project operate?


Payroll usually operates from Sunday to Saturday. Normally, you would start on Monday and finish on Friday. Use Date Format (MM/DD/YY) exactly as shown.
Start Date: *
(MM/DD/YY)
End Date: *
(MM/DD/YY)
Required Positions


List position(s) required to carry out the project by position title, start and finish dates and duration.
Supervisor Position


Working Title:
Start Date:
(MM/DD/YY)
Finish Date:
(MM/DD/YY)
Number of Weeks:
Requirements:
State the preferred education/skill/work experience for each position.
Position Title 2


Working Title: *
Start Date: *
(MM/DD/YY)
Finish Date: *
(MM/DD/YY)
Number of Weeks: *
Requirements:
State the preferred education/skill/work experience for each position.
Position Title 3


Working Title:
Start Date:
(MM/DD/YY)
Finish Date:
(MM/DD/YY)
Number of Weeks:
Requirements:
State the preferred education/skill/work experience for this position.
Position Title 4


Working Title:
Start Date:
(MM/DD/YY)
Finish Date:
(MM/DD/YY)
Number of Weeks:
Requirements:
State the preferred education/skill/work experience for this position.
Position Title 5


Working Title:
Start Date:
(MM/DD/YY)
Finish Date:
(MM/DD/YY)
Number of Weeks:
Requirements:
State the preferred education/skill/work experience for this position.
Position Title 6


Working Title:
Start Date:
(MM/DD/YY)
Finish Date:
(MM/DD/YY)
Number of Weeks:
Requirements:
State the preferred education/skill/work experience for this position.
Is your project a new initiative? If not, explain why the project is being revived.


:
Was your project proposal previously funded through a government program? If so, indicate the name of the program and attach a project summary of activities carried out.


:
What long-term benefits will be derived from your proposed project?


:
Please calculate the amount of funds your project will require.


:
Total Number of Position Weeks X Minimum wage + 4% Vacation Pay X (Hours/Week)
If you want to insert additional information about your project, please attach a Word or Word Perfect file.


Additional Information:
Declaration: *
I certify that the foregoing statements made by me are true in substance.




I authorize the PE I Employment Development Agency and the PE I Department of Fisheries, Aquaculture and Rural Development to verify the above information, to obtain or release information pertaining to m y suitability for employment and/or toobtain or release confidential information on employment insurance eligibility to be use d only for the purpose o f providing employment opportunities.

Do you want a copy of the form?


Please send me a simple text-only version of the information I submitted.
Please send me an Acrobat version of the form, with the information I've entered above filled in, that I can print and save.
Please send me both the text-only version and the PDF.
Important Note: Email is not, by its very nature, a secure medium; if you choose to have your form emailed to you, the information you entered will be transmitted over the public Internet to your email box.

Email to address:

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When you click here, the information you've entered above will be sent to the public servant responsible for receiving and processing this form. If you've opted to receive an Acrobat version of the form by email, you will receive this file shortly.
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