Head of a single parent family
Language of correspondence
Immigration status
Are you considered a refugee claimant?

The following information will help Emploi Québec determine which service is best suited to the individual’s needs.

Does the person have a functional limitation (physical, intellectual, mental)?
STUDIES COMPLETED IN QUEBEC : specify your field of specialization if applicable
Employment Insurance Status
Are you studying now?

It is not mandatory to answer the following question:

Does the person identify as a member of a visible minority?

I declare that the information provided is true. I authorize Emploi-Québec and the external response to share the information necessary to research and track my participation in the activity described in the Activity Intelligence section.

By submitting this form, I agree that the information entered will be used strictly in connection with my application.