LOCALS 175 & 633
YOUTH LEADERSHIP DEVELOPMENT PROGRAM
APPLICATION FORM
Applicant Information
First Name:
Last Name:
E-mail:
Permanent Home Address:
City:
Province:
Select...
Ontario
Northwest Territories
Nunavut
Quebec
Newfoundland
Prince Edward Island
Nova Scotia
New Brunswick
Manitoba
Saskatchewan
Alberta
British Columbia
Yukon
Postal Code:
Telephone:
(
)
-
Workplace
Years as a member
Are you under 30 years of age?
Yes
No
Are you a member of your workplace Joint Health & Safety Committee?
Yes
No
What other Union exposure/activities have you been involved in, if any? (Labour Council, Labour Day Parade, Leukemia Events, etc.).
In point form, please answer: How do you feel you would benefit from taking this program?