Intake Form

Please complete the details below to fill out the Intake Form.

  • If you do not have a Home Phone Number, enter ‘0’
    If you do not have a Cell Phone Number, enter ‘0’
    eg. Box 69, Russell, MB R0J 1W0
    yyyy-mm-dd
    If Not Employed/Unemployed, enter NA
    If Not Employed/Unemployed, enter ‘0’
    If Not Employed/Unemployed, enter ‘0’
    eg. 2002
    Year Only

An Employment Officer will contact you by phone/email to arrange an appointment time. Please check your junk/spam email folder as well incase our communication email ends up in there.

Alternatively, you can fill out the PDF below* and email it to admin@regionalemployment.ca

INTAKE FORM PDF VERSION

* Don’t forget to save the PDF before attaching it to your email or it will send as a blank form