ᓄᓇᒃᑰᕈᑎᕐᔪᐊᓂᑦ ᐅᖁᒪᐃᑦᑐᓕᕆᔾᔪᑎᓂᑦ ᐊᖁᑎᐅᓂᕐᒥᒃ

ᑐᕌᒐᓪᓗᐊᑕᓖᑦ ᕿᑭᖅᑕᓂ−ᑲᑐᔾᔨᖃᑎᒌᒍᑕᐅᔪᒥ ᐊᒥᓱᕈᒃᑲᓐᓂᖁᓪᓗᒋᑦ ᐃᓄᐃᑦ ᐃᖅᑲᓇᐃᔭᕐᐸᑦᑐᑦ ᕿᑭᖅᑕᓂ ᓴᓇᕕᐅᕙᑦᑐᓂᑦ ᓲᓗᕐ ᐅᔭᕋᓐᓂᐊᕐᕕᒻᒥ. ᕿᑭᖅᑕᓂ−ᑲᑐᔾᔨᖃᑎᒌᒍᑕᐅᔪᖅ ᓇᓗᓇᐃᒃᑯᑕᖅᑖᕈᑕᐅᖃᑦᑕᓂᐊᖅᑐᓂᑦ ᐊᒻᒪᓗ ᐊᓯᖏᓐᓄᑦ ᐊᑐᖅᑕᐅᔪᓐᓇᖅᑐᓂᑦ ᐃᓕᓐᓂᐊᑎᑦᑎᕙᑦᑐᑦ ᐃᓕᓐᓂᐊᑎᑦᑎᒍᑎᒋᕙᑦᑕᖏᑎᒍᑦ ᐃᓄᓐᓂᑦ ᓄᓇᓕᓐᓂᑦ ᕿᑭᖅᑕᓂ.

ᕿᑭᖅᑕᓂ−ᑲᑐᔾᔨᖃᑎᒌᒍᑕᐅᔪᖅ ᐱᖓᓲᔪᖅᑐᓂᑦ−ᐱᓇᓱᐊᕈᓯᕐᓂᑦ ᓄᓇᒃᑰᕈᑎᕐᔪᐊᓂᑦ ᐊᖁᑎᐅᓂᕐᒥᒃ ᐃᓕᓐᓂᐊᑎᑦᑎᖃᑦᑕᓲᑦ ᒧᐊᕆᔅᕘᒃ, ᐋᓐᑎᐅᕆᐅᒥ. ᑖᓐᓇ ᐃᓕᓐᓂᐊᕈᑕᐅᓲᖅ ᐱᔭᕇᕐᓯᓯᒪᔪᓄᑦ ᐱᕙᓪᓕᐊᒍᑕᐅᔪᓐᓇᐸᒻᒪᑦ ᐊᑑᑎᓕᓐᓂᑦ ᐃᖅᑲᓇᐃᔮᖃᕐᓂᕐᒥᒃ ᐅᔭᕋᓐᓂᐊᕐᕕᓐᓂᑦ ᐅᕝᕙᓘᓐᓃᑦ ᐃᖅᑲᓇᐃᔮᖅᑖᕈᑕᐅᓲᖑᓪᓗᓂ ᓄᓇᖏᓐᓂ.

ᑖᓐᓇ ᐱᔭᕇᑦᑎᐊᕐᓂᐊᕋᕕᐅᒃ ᐱᓇᓲᑏᑦ, ᐱᔭᕇᕐᓯᓯᒪᒋᐊᖃᖅᑐᑎᑦ ᐃᖅᑲᓇᐃᔮᖅᑖᕋᓲᑎᓐᓂᒃ ᐊᒻᒪᓗ ᐱᕋᔭᓚᐅᕐᓯᒪᒻᒪᖔᕐᐱᑦ ᖃᐅᔨᓴᖅᑕᐅᔾᔪᑎᖃᕆᐊᖃᕋᔭᖅᑐᑎᑦ.

ᑐᑭᓯᒃᑲᓐᓂᕈᒪᒍᔅᓯ:

ᕿᑭᖅᑕᓂ ᐱᓕᒻᒪᔅᓴᐃᓂᕐᒧᑦ ᐃᓕᓐᓂᐊᑎᑦᑎᓂᕐᒧᓪᓗ ᐃᖅᑲᓇᐃᔮᔅᓴᓄᑦ ᑲᑐᔾᔨᖃᑎᒌᒍᑕᐅᔪᖅ

ᑐᑭᓯᒋᐊᕐᓗᓯ ᐅᕗᖓ Tuttarvik.qia.flywheelsites.com

ᐃᕐᖐᓈᖅᑕᐅᑖ tuttarvik@qia.flywheelsites.com

Q-STEP - Heavy Equipment

Step 1 of 5

Personal Information / ᐃᕝᕕᑦ ᒥᔅᓵᓄᑦ ᑐᑭᓯᐅᒪᔾᔪᑎᔅᓴᑦ
All fields with * are required / ᑎᑎᖅᓯᒪᔪᓕᒫᑦ ᐅᓪᓗᕆᐊᕐᖑᐊᓕᖕᒥ * ᑕᑕᑎᖅᑕᐅᒋᐊᖃᖅᑐᑦ
Please enter your name / ᐊᑏᑦ ᑎᑎᕋᙳᐊᑕᕐᓯᓐᓇᕈᒃ*
First Name / ᐊᑏᑦ Last Name / ᐊᑎᕈᓰᑦ
Gender / ᐊᕐᓇᐅᕕᑦ/ᐊᖑᑕᐅᕕᓪᓘᓐᓃᑦ*
- Male / ᐊᖑᑏᑦ
- Female / ᐊᕐᓇᐃᑦ
- Other / ᐊᐃᑉᐹ
Date of Birth / ᑎᑎᕐᓯᕕᒋᓗᒍ ᐅᑭᐅᑎᑦ ᓇᓛᓃᕝᕕᖏᑦ
Day / ᐅᓪᓗᖅ*
Month / ᑕᖅᑭᖅ*
Year / ᐊᕐᕌᒍ*
Select your community / ᓂᕈᐊᕆᑦ ᓄᓇᖃᕐᕕᓐᓂᒃ*
NTI number / ᓄᓇᕗᑦ ᑐᙵᕕᒃᑯᓐᓂᑦ ᐃᓚᒋᔭᐅᔾᔪᑏᑦ ᓈᓴᐅᑖ*
Do not include dashes or spaces with your NTI number / ᐱᖃᓯᐅᔾᔨᑦᑕᐃᓕᒋᑦ ᑎᑎᖅᓯᒪᔪᓂᑦ ᓈᓴᐅᑎᐅᙱᑦᑐᓂᑦ ᐊᒻᒪᓗ ᑲᑎᙵᑎᑦᑕᐃᓐᓇᕆᓗᒋᑦ ᓄᓇᕗᑦ ᑐᙵᕕᒃ ᑎᒥᖓᓄᑦ ᓈᓴᐅᑎᕆᔭᑎᑦ
SIN Number / ᐃᖅᑲᓇᐃᔭᖅᑐᕐᓯᐅᑦ ᓈᓴᐅᑏᑦ*
Mailing Address / ᑎᑎᖅᑲᓂᐊᕐᕕᒃᑯᑦ ᑐᕌᕈᑖ*
PO Box / ᑎᑎᖅᑲᓂᐊᕐᕕᒃᑯᑦ ᑐᕌᕈᑖ Community / ᓄᓇᓕᒃ Province / ᓄᓇᓕᐅᑉ ᐊᕕᒃᑐᖅᓯᒪᓂᕆᔭᖓ Postal Code / ᑎᑎᖅᑲᓂᐊᕐᕕᒃᑯᑦ ᓇᓗᓇᐃᒃᑯᑕᖓ
Phone / ᐅᖄᓚᐅᑖ*
Email / ᐃᕐᖐᓈᖅᑕᐅᑖ*
Alternate Contact / ᐅᖃᕐᕕᐅᖔᕈᓐᓇᖅᑐᖅ*
Alternate Contact Phone Number / ᐅᖄᓚᕕᐅᖔᕈᓐᓇᖅᑐᖅ ᐅᖄᓚᐅᑖ*
Do you have any children/dependents? / ᕿᑐᕐᖓᖃᖅᐲᑦ/ᐸᖅᑭᔭᖃᖅᐲᑦ?*
- Yes / ᐄ
- No / ᐋᒡᒐ
How many children/dependents (under 18 years old)? / ᖃᑦᑎᓂᑦ ᕿᑐᕐᖓᖃᖅᐱᑦ/ᐸᖅᑭᔭᖃᖅᐳᑦ (ᐅᑭᐅᓖᑦ 18 ᑐᖔᓂᓗ)?*

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Declaration and authorization to release information / ᓇᓗᓇᐃᖅᓯᔾᔪᑎ ᐊᒻᒪᓗ ᐱᔪᓐᓇᐅᑎᑦᑎᔾᔪᑎ ᓴᒃᑯᑕᐅᖁᓪᓗᒋᑦ ᑐᑭᓯᒋᐊᕈᑏᑦ
All fields with * are required / ᑎᑎᖅᓯᒪᔪᓕᒫᑦ ᐅᓪᓗᕆᐊᕐᖑᐊᓕᖕᒥ * ᑕᑕᑎᖅᑕᐅᒋᐊᖃᖅᑐᑦ
I, the undersigned, give my consent for Qikiqtani Inuit Association to release the information contained in this form regarding my participation in the Heavy Equipment Operator training. I acknowledge that the information is collected and administered in accordance with the Privacy Act and applicable to privacy laws, and that it may be used to determine my eligibility for the Heavy Equipment Operator training. / ᐅᕙᖓ, ᐊᑎᓕᐅᖅᑎᐅᓪᓗᖓ ᐊᓪᓕᕐᒥ, ᐊᖏᖅᐳᖓ ᕿᑭᖅᑕᓂ ᐃᓄᐃᑦ ᑲᑐᔾᔨᖃᑎᒌᖏᑦ ᓴᒃᑯᐃᒍᓐᓇᕐᒪᑕ ᑐᑭᓯᒋᐊᕈᑎᓂᑦ ᑕᒡᕙᓃᑦᑐᓂᑦ ᓈᑎᕆᐊᓕᒻᒥ ᐱᔾᔪᑎᓕᒃ ᐃᓚᐅᖃᑕᐅᓂᐊᕐᓂᕋ ᐅᖁᒪᐃᑦᑐᓂᑦ ᓄᓇᓯᐅᑎᓂᑦ ᐊᖁᒋᐅᖅᓴᓂᕐᒧᑦ ᐃᓕᓐᓂᐊᕋᔭᖅᑕᓐᓂᑦ. ᐃᓕᓴᖅᓯᕗᖓ ᑐᑭᓯᒋᐊᕈᑏᑦ ᓄᐊᑕᐅᔪᑦ ᐊᒻᒪᓗ ᐊᐅᓚᑕᐅᔪᑦ ᒪᓕᑦᑐᒋᑦ ᑲᙳᓇᖅᑐᒦᑎᑦᑎᒋᐊᖃᕐᓂᕐᒧᑦ ᐱᖁᔭᕐᒥᒃ ᐊᒻᒪᓗ ᐊᑐᖅᑕᐅᔭᕆᐊᓖᑦ ᑲᙳᓇᖅᑐᒦᑎᑦᑎᓂᕐᒧᑦ ᐱᖁᔭᑦ, ᐊᑐᖅᑕᐅᔪᓐᓇᕋᔭᕐᒪᑕ ᑕᒪᒃᑯᐊ ᐃᓱᒪᓕᐅᖅᑐᖃᕐᓗᓂ ᐱᖃᑕᐅᔪᓐᓇᕋᔭᕐᓂᓐᓂ ᐅᖁᒪᐃᑦᑐᓂᑦ ᓄᓇᓯᐅᑎᓂᑦ ᐊᖁᒋᐅᖅᓴᓂᕐᒧᑦ ᐃᓕᓐᓂᐊᕋᓱᐊᕈᑎᓐᓄᑦ.*
- I agree
Please enter your name / ᐊᑏᑦ ᑎᑎᕋᙳᐊᑕᕐᓯᓐᓇᕈᒃ*
First Name / ᐊᑏᑦ Last Name / ᐊᑎᕈᓰᑦ
Day / ᐅᓪᓗᖅ*
Month / ᑕᖅᑭᖅ*
Year / ᐊᕐᕌᒍ*
Today's Date / ᑎᑎᕐᓯᕕᒋᓗᒍ
Comments
This field is for validation purposes and should be left unchanged.

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ᓄᓇᒃᑰᕈᑎᕐᔪᐊᓂᑦ ᐅᖁᒪᐃᑦᑐᓕᕆᔾᔪᑎᓂᑦ ᐊᖁᑎᐅᓂᕐᒥᒃ

Q-STEP - Heavy Equipment

Step 1 of 5

Personal Information / ᐃᕝᕕᑦ ᒥᔅᓵᓄᑦ ᑐᑭᓯᐅᒪᔾᔪᑎᔅᓴᑦ

Income & Employment / ᑮᓇᐅᔾᔭᒃᓵᑦ ᐊᒻᒪᓗ ᐃᖅᑲᓇᐃᔭᕐᓃᑦ

Education & Childcare / ᐃᓕᓐᓂᐊᖅᓯᒪᓃᑦ ᐊᒻᒪᓗ ᐸᐃᕆᔨᖃᕆᐊᖃᕐᓃᑦ

Heavy Equipment Operator Training / ᓄᓇᒃᑰᕈᑎᕐᔪᐊᓂᑦ ᐅᖁᒪᐃᑦᑐᓕᕆᔾᔪᑎᓂᑦ ᐊᖁᑎᐅᓂᕐᒥᒃ";

Declaration and authorization to release information / ᓇᓗᓇᐃᖅᓯᔾᔪᑎ ᐊᒻᒪᓗ ᐱᔪᓐᓇᐅᑎᑦᑎᔾᔪᑎ ᓴᒃᑯᑕᐅᖁᓪᓗᒋᑦ ᑐᑭᓯᒋᐊᕈᑏᑦ

Job title / ᐃᖅᑲᓇᐃᔮᑉ ᑕᐃᔭᐅᓂᖓ	Reason for leaving / ᐱᔾᔪᑏᑦ ᐃᖅᑲᓇᐃᔭᕈᓐᓃᖅᑐᒥᓂᐅᓂᕐᓄᑦ

Training / Course / ᐱᓕᒻᒪᒃᓴᖅᑕᒥᓃᑦ / ᐃᓕᓐᓂᐊᒐᒃᓴᖅ ᐃᓕᓐᓂᐊᖅᑕᒥᓃᑦ	Length / ᐊᑯᓂᐅᓂᖓ	Year Completed / ᐊᕐᕌᒍ ᐱᔭᕇᖅᑕᒥᓃᑦ