REVISED Application Form 2019 NOTE: Intro Shop Steward Workshop must be completed before applying for. Region Nanaimo February 26, 27 Workshop Locations Open To Attend Application Deadline Nanaimo, Campbell River, Courtenay, North and Central Island, Tofino, Ucluelet January 25 Nanaimo February 28, March 1 Nanaimo, Campbell River, Courtenay, North and Central Island, Tofino, Ucluelet January 25 Kamloops March 5, 6 Kamloops, Lillooet, Merritt, 100 Miles, Salmon Arm, Revelstoke, Cariboo-Chilcotin, South Cariboo February 1 Kamloops March 7, 8 Kamloops, Lillooet, Merritt, 100 Miles, Salmon Arm, Revelstoke, Cariboo-Chilcotin, South Cariboo February 1 March 12, 13 February 8 March 14, 15 February 8 Kelowna April 2, 3 South Okanagan, Oliver, Osoyoos, Princeton, Keremeos, Penticton, Summerland, Central Okanagan, Vernon, Enderby, Armstrong, West March 1 Kelowna April 4, 5 South Okanagan, Oliver, Osoyoos, Princeton, Keremeos, Penticton, Summerland, Central Okanagan, Vernon, Enderby, Armstrong, West March 1 Victoria April 9, 10 Greater Victoria, Sooke, Saanich, Gulf Islands March 8 Victoria April 11, 12 Greater Victoria, Sooke, Saanich, Gulf Islands March 8
Region Prince George May 14, 15 Workshop Locations Open To Attend Application Deadline Quesnel, Burns Lake, Vander hoof Prince George, Fraser Lake, Fort St. James, Mackenzie, Chetwynd First Nations Collective Agreements, Queen Charlotte Hospital, Masset Hospital, Skidegate, Nisga'a and Gitxsan, Peace River North and South, Fort Nelson, Tumbler Ridge April 12 Prince George May 16, 17 Quesnel, Burns Lake, Vander hoof Prince George, Fraser Lake, Fort St. James, Mackenzie, Chetwynd First Nations Collective Agreements, Queen Charlotte Hospital, Masset Hospital, Skidegate, Nisga'a and Gitxsan, Peace River North and South, Fort Nelson, Tumbler Ridge April 12 Nelson April 24, 25 Nelson, Castlegar, Arrow Lakes, Trail, North, South, and East April 19 Nelson June 26, 27 Nelson, Castlegar, Arrow Lakes, Trail, North, South, and East April 19 November 5, 6 October 4 November 7, 8 October 4 Send application (complete ALL pages) by fax, email, or mail to: FAX: 604-739-1510 Email: MAIL: vphillips@heu.org HEU Provincial Office EDUCATION DEPARTMENT Attention: Vickie Phillips 5000 North Fraser Way, BC V5J 5M3 DATE SENT: # OF PAGES: Page 2 of 5
INTRO SHOP STEWARD WORKSHOP PLEASE PRINT CLEARLY IN DARK INK SECTION A PERSONAL INFORMATION Last Name: First Name: Have you recently moved? Yes No If yes, when? Address: Apt/Suite: City: Postal Code: Mailing Address (if different): Home Phone: Cell: Work Phone (include ext#): Extension: Personal email: Job Title: Dept: Employer: Work Site: Local: What union position (if any) do you hold at your Local? Employment Status: Full-time Part-time Casual Region: North Interior Vancouver Coastal (includes PHSA) Fraser Vancouver Island I identify my gender as: Do you identify as a member of any of the following equity-seeking groups or as a young worker? LGBTQ2S+ Indigenous People with disabilities Person of Colour Women Young Worker (33 years or younger) Emergency contact (Name & Phone): Medical Condition /Special Accommodation Do you have any medical condition(s) or require special accommodations that we should be aware of, that could impact your ability to participate in this event? Yes No If yes, please briefly explain. (In some cases, a Physician s note may be required) _ Page 3 of 5
SECTION B APPLICANT S QUESTIONNAIRE Questions A, B, & C must be filled out by and applicants: A. Why do you want to attend this workshop? B. How will you use the skills you learn at the workshop? C. How will your own experience add to the workshop? Questions D & E must be filled out by applicants: D. Indicate where and when you have previously taken shop steward training: E. How long have you been handling grievances? (12 months required) Signature of Applicant You will be notified by mail if your application is accepted. Due to a limited amount of space, we may not be able to accept all applications. We will notify you by mail if you are not successful. Page 4 of 5
SECTION C WORKSHOP INFORMATION HEU Members Name: HEU Local: of workshop: Location of workshop: Level applying for: Send application (complete ALL pages) by fax, email, or mail to: FAX: 604-739-1510 Email: MAIL: vphillips@heu.org HEU Provincial Office EDUCATION DEPARTMENT Attention: Vickie Phillips 5000 North Fraser Way, BC V5J 5M3 DATE SENT: # OF PAGES: Page 5 of 5