Labour Forms

In fo rm atio n an d P rivacy O ffice
L abour 4th Floor Labour Building

10808 - 99 Avenue
Edmonton, Alberta T5K 0G5
Telephone 780-644-2397
Fax 780-415-0070
http://foip.gov.ab.ca
March 4, 2016
James Johnson
5001 Federal Building
9820 107 Street
Edmonton AB T5K 1E7
Dear Mr. Johnson:
RE: Freedom of Information and Protection of Privacy Act

Request for General Information
File Number: 2016-G-0017
The Information and Privacy Office has processed your request for access to
information under the Freedom of Information and Protection of Privacy Act (FOIP Act),
which we received on February 1, 2016.
Enclosed are 58 pages of responsive records.
If you have any concerns or questions about a decision made during the processing of
your request, please contact me at 780-422-7365.
If we are unable to resolve your question or concern, under section 65(1) of the FOIP
Act, you may ask the Information and Privacy Commissioner to review this decision. To
request a review, you must complete and deliver a Request for Review form within 60
calendar days from the date of this letter to the Commissioner at 410, 9925 - 109
Street, Edmonton, Alberta, T5K 2J8. The form is available under the Resources tab on
the Commissioner’s website at www.oipc.ab.ca or you can call 1-888-878-4044 to
request a copy of the form.
Ivlelissa Banks
ADM, Corporate Services & Information
Enclosure
Government Board & C om m ittee M em ber Expense Claim
Jobs, Skills. Training and Labour
The information you provide is collected pursuant to the Freedom of Information and Protection of Privacy Act (FOIP Act) and will he managed in accordance
with the privacy provisions in the Act If you have any questions regarding ihe collection of personal information, please contact the information and Privacy
Office at 780-644-2397
Personal Inform ation

Last Name First Name Vendor ID # (optional!
Mailing Address City Province/Terntory Postal Code

AB
Claim Information: Claims reimbursed based on Travel and Subsistence Regulation
Name of Board or Committee
Purpose of Trip
Departure Date (yyyy-mm-ctd) Departure Time Return Date (yyyy-rnm-dd) Return Time
Expense C ategory A m ount
Private V ehicle Rate: $0.505/Km No. of Km $0.00

Airfare (Attach ticket copy or boarding pass)
O ther T ransportation (Attach receipts) i.e. Bus, Rail, Taxi etc.
A ccom m odation (Attach receipts)

A m ount w ith R eceipts
M eals Rate Q uantity
(Detailed Receipts if over allowance)
B reakfast $9.20 $ 0 .0 0
Lunch $11.60 $ 0 .0 0
D inne r $20.75 $ 0 .0 0
Per D iem Q ln Country $7.35

(24hr penod) Q Out-of-Country $14.65 $ 0 .0 0
Other Expenses (List and attach receipts) i.e. Parking. Phone. Photocopying etc.
I certify that the above claim was incurred on governm ent business and that T0 tai
amounts claim ed have not previously been paid to me or m y behalf, nor have
they been charged to a government issued credit card
Date (yyyy-mm-dd) Member's Name Signature of Member
Date iyyyy-mm-M) Expenditure Officer's Name Signature of Expenditure Officer
ADMINJSTL0004 (2015/05) Page 1 of 1
Page 1
Reference Number
Canada Government
* * C anada-A lberta Job G rant A pplication
The personal Information you provide on this form is being collected by the Government of Alberta to determine eligibility for the Canada
Job Grant Program If you choose to apply, the personal information you provide will be used in the application process, for ongoing
eligibility verification, to monitor, assess and evaluate the effectiveness of services provided and to evaluate the results of provincial and
federal programs. Upon approval of a grant application, the grant recipient, the grant program and the grant amount may be published on
the Government of Alberta Grant Disclosure Portal,
Personal information provided to the Government of Alberta is collected, disclosed and retained under the authority of the Freedom o f
Information and Privacy Act. If you have any questions about the collection of personal information, please contact: 1-855-63&-9424.
Instructions
• Fill out this form on your computer.
• Save the completed form to your hard drive.
• Print the form, sign it, and mail it a minimum of 30 days prior to training start date to
Canada-Alberta Job Grant

Jobs. Skills, Training and Labour
P.O. Box 840 Edmonton Main
Edmonton. AB
T5J 2L4
• Refer to the Applicant Guide available on the Canada-Alberta Job Grant website for assistance in completing this
form.
Part A - Employer Information

Employer Information
Alberta Corporate Access Number: Legal Entity Name
Operating Name. Mailing Address:
City: Province: Postal Code
Country: Phone Number Fax Number:
Business Address: (if different from mailing address above) City:
Province: Postal Code. Country: Number of Employees:

□ % 50 G 51-499 [ ] 500+
Primary Sector (Please select only one.):
Employer Contact
First Name: Last Name: Position Title.
Phone Number: Alternate Phone Number: Email Address:
CJGQ001 (2015/08) Page 1 of 5
Page 2
Part B Training Information
The intent of the Canada Alberta Job Grant is not to replace regular operational training. Rather, the intent is to support training that would
not take place without the grant. In order to determine if the requested training is eligible for funding, please answer the following
questions:
□ Yes □ N o
(1) Will this training take place without Canada-Alberta Job Grant funding?
□ Yes QNo
(2) Has the training already been paid for?
(3) Has this training already started? L r 65 QN°
If you answered 'yes’ to any of the questions above, the requested training is not eligible for Canada Alberta Job Grant funding.
Training Program
Course Title: Delivery Method:

□ C lassroom □ W orkplace □ O n lin e □ D istance □ B lended
Hours of Training per Trainee: Start Date lyyyy-mm-cid) End Date (yyyy-mm-dd):
Credential/Certificate Awarded on Completion:

□ Educational credential or certificate
□ in d u s try or occupation credential or certificate
□ P roprietary (firm issued) credential or certificate (third party training curriculum that is specific to a company and/or workplace)
□ N o credential/certification to be awarded
Type of Training:
□ E n try level
□ U pskilling or Upgrading
□ M aintenance (training required for the Trainee to stay in their current job)
Type of Skills to be Learned by the Trainee:
□ E sse n tia l Skills
□ S pecialized or technical skills
□ M anagem ent and business skills
□ S o ft skills
Desired Outcomes of Training: (select all that apply)
□ in cre a se productivity of Trainee
□ in tro d u ce new technology, machinery/equipment and/or new processes
□ F o s te r innovation in the business/workforce
□ D e ve lo p leadership potential of Trainee

Training Provider
Provider Type:
□ U n iv e rs ity □ C o lle g e □ T ra d e /T e ch n ica l School □ U n io n Hall □ P riv a te Trainer □ O th e r □ C o m b in a tio n
Provider Name: Provider Contact Person Contact Person Phone Number:
Mailing Address.
City: Province: Postal Code:
Paae3
Country: Phone Number: website:
satisfactory to the Minister a request for reimbursement of Training Costs, including information related to the
Trainee and Original Receipts for all Training Costs, and once the Minister approves the request, the Minister shall
provide 50'% of the Grant
(b) Within thirty (30) days o f the Trainee completing the Training Program, the Employer shall submit, in a form
satisfactory to the Minister, an evaluation report setting out what was accomplished with the grant proceeds and/
or what results were achieved and once the Minister approves the report, the Minister shall provide the
remaining 50% of the Grant
3. In the event a Trainee does not complete the Training Program and any Training Costs are refunded, the Employer must notify
the Minister and the Grant shall be reduced accordingly
4 The Employer shall maintain adequate financial records relating to this grant. It shall keep proper books, accounts and records of
the cost of the program or project in accordance with generally accepted accounting principles, and have them available at all
times dunng the Term of the Agreement and for a period of two (2) years after the termination or concision of this Agreement.
5 The Employer, during the Term and for two (2) years after the termination or conclusion of this Agreement, shall produce on
demand to any representatives of the Minister, or the Auditor General of Alberta, any of the books, accounts and records referred
to m section 1 4 and shall permit those representatives to examine and audit these accounts, records and documents and take
copies and extracts of them to determine that the Employer has complied or is complying with the conditions of the grant
6 The Employer, during the Term and for two (2) years after the termination or conclusion of this Agreement shall provide to the
Minister, on request, any information the Minister considers necessary to determine how the grant proceeds have been or are
being spent.
7. Ownership of any work or materials including copyright, patent, industnal design process or trademark developed or produced
under this Agreement by the Employer, vests in the Employer
8 The use of the grant proceeds must not result in a conflict of interest Should the Employer be aware of a conflict of interest, the
Employer must contact the Minister The Minister will determine whether the circumstances are such that the grant funding may
continue.
9. The Employer acknowledges and agrees that the Department of Jobs Skills. Training and Labour is a public body and must
comply with the Freedom o f Information and Protection of Privacy Act. R S A. 2000. c F-25. The Minister is not able to guarantee
confidentiality of any documents submitted to and accepted by the Minister All documents, not limited to but including records
and reports mentioned in this Agreement, including those marked '‘Confidential", may be found to be in the custody o f or under
the control of the Minister and will be subject to the privacy and disclosure provisions of the Freedom of Information and
Protection o f Privacy Act. The Act allows any person a right of access to records in the custody or the control of a public body
subject to limited and specific exemptions If the Minister receives a request for access, the Employer agrees to consult and
cooperate with the Minister to enable the Minister to properly respond to the request for access
10. Information provided by the Employer and the Trainee pursuant to this Agreement will be provided to the Government of Canada,
pursuant to an Information Sharing Agreement entered into between the Minister and the Government of Canada
11. The Employer confirms that the training to be provided is suitable for public funding and is not in conflict with or potential conflict
wilh the Minister s Mission. Values and Beliefs
12 The employer shall not accept any other funding to subsidize the training of the trainee funded under this contract.
3. TERM:
The term of this Agreement shall commence when the Minister approves the Employer's Canada-Alberta Job Grant application
and shall terminate when the Minister approves the report described in s 2 2(b).
4. TERMINATION or COMPLETION:
1 The Minister reserves the right to terminate this Agreement at any time, without reason or cause, by giving thirty (30) days notice
in writing to the other party of his intention.
2 The parties by mutual agreement may terminate this Agreement in full or in part at any time
3. Upon termination of this agreement in accordance with sections 4 1 or 4 2 or expiry of the term of this Agreement, the Employer
shall within sixty (60) days or within another timeframe as directed by the Minister, submit a certificate signed by the appropriate
representative confirming that the grant proceeds were only used in accordance with the Canada-Alberta Job Grant Program and
the terms and conditions of this Agreement, and a financial report detailing the actual amount of grant proceeds expended
4. Notwithstanding anything contained herein to the contrary, the Minister may request, and the Employer shall refund forthwith, all
or part of the grant proceeds to the Minister should the Employer fad to fulfill any of the terms and conditions !§9fefein set out
and the Minister shall have absolute discretion in determining whether a term or condition is fulfilled
£ R C U C D A I O D n W IC in tlC -
Training Cost
Enter total costs for all trainees in this section, including GST that will not be claimed on the employer's GST returns
All amounts must be in Canadian Dollars.
Number of Trainees to receive train ng. (each trainee must complete sign and submit a Canada-Alberta Job Gran! Tralee Information form along this application form)
l
Tuition or Instructional Fees Mandatory Student Fees. TextbooKs Software, and Other Required Matenals Examination Fees'
Total Training Costs Government Contribution (2/3 of total training costs) Government Contribution per Trainee.
$ 0 .0 0 $ 0 .0 0 $ 0 .0 0
• Only training costs paid for after the Canada Alberta Job Grant application has been dated and signed are eligible for funding
• All trainees must meet the eligibility criteria for training costs to be reimbursed
• Ail trainees must be taking the same training at the same time.
■ Attach a quote in Canadian dollars from the training provider
• Employers will only be reimbursed (to a maximum of $300 000 per fiscal year) for eligible expenses for which they have original receipts
from the training provider
• Employers must contnbute a minimum of 1/3 of the total training costs. Maximum government contribution is $10,000 per Trainee
Canada-Alberta Job Grant Terms and Conditions:

THE PARTIES AGREE AS FOLLOWS:
1. DEFINITIONS
In this Agreement.
"Em ployer1' means an eligible employer approved by the Minister in respect of whom a Canada-Alberta Job Grant may be paid, and
includes individual employers and organizations acting on behalf of employers in the private and not-for-profit sectors
G ra n f means the funds approved by the Minister pursuant to this Agreement to reimburse the Employer up to two-thirds (2/3) of
the eligible Training Costs to a maximum of $10,000 per trainee and/or $300,000 maximum per employer per fiscal year
M inister' means Her Majesty the Queen in Right of Alberta, as represented by the Minister of Jobs, Skills. Training and Labour
'Trainee' means a person identified by the Employer and approved by the Minister whether currently employed by the Employer or
not. as someone who would benefit from completing a Training Program to acquire skills to obtain a new or better job with the
Employer To be eligible for funding under the Canada-Alberta Job Grant a Trainee must be a Canadian Citizen. Permanent
Resident or Protected Person under Canada's Immigration and Refugee Protection Act. as amended The following persons are not
eligible to be a Trainee:
- a person working in Canada on a temporary basis.
- an immediate family member of the Employer
- self-employed individuals and business owners.
- a member of the Board or Council of the Employer, or
- a person who will not be employed by the Employer or their designate after the Training Program is completed
‘Training C osts' means the direct training costs incurred by the Employer and approved by the Minister to train the Trainee under a
Canada-Alberta Job Grant and is limited to:
-tuition fees or fees charged by the Training Provider.
-mandatory student fees.
-textbooks, software and other required materials, and
-examination fees
For greater certainty. Training Costs do not include basic income support to the Trainee or costs of financial assistance to the
Training Provider for training infrastructure costs or curriculum development costs.
Training Program means an incremental program of training that is approved by the Minister for the purposes of the Canada-
Alberta Job Grant
Training P ro vid e r means a third party trainer recognized by the Minister to deliver a Training Program to the Trainee.
2. UNDERTAKINGS AND CONDITIONS RELATED TO THE GRANT:
1 The whole amount of the grant proceeds shall only be used for the purpose described in the Canada-Alberla Job Grant Program
and in accordance with the requirements of the Government Organization Act and the Employment and Immigration Grant
Regulation, as amended.
2 Upon receipt of the Canada-Alberla Job Grant application and subject to the Employer complying with the terms and conditions
o f this Agreement, the M inister will pay the grant proceeds to the Employer in the following m anner
(a) W ithin thirty (30) days o f paying for the Training Program, the Employer shall submit, in a form
CJG0001 (2015/08) Page 3 of 5
Page 5
4 Nothing in this Agreement makes, or shall be construed to make the Trainee or the Employer or any of its employees, agents or
volunteers an agent of the Minister Nothing in this Agreement creates, or shall be construed to create an employer-employee
relationship or a partnership between the Minister and the Trainee or the Employer or any of its employees, agents or volunteers.
5. The Employer shall not incur any expenses or debts on behalf of nor make any commitments for the Minister.
6. The Minister's responsibility pursuant to this Agreement is limited solely to the provision of financial assistance in accordance with
the terms and conditions set out herein
7 All notices referred to herein shall be given m writing and addressed to the Minister as follows.
Jobs. Skills. Training and Labour
Edmonton. AB
T5J 2L4
All notices referred to herein shall be given in writing and addressed to the Employer as identified on the Canada-Alberta Job
Grant Application Form
Employer's Representative
All notices referred to herein shall be given in writing and addressed to the Employer as identified on the Canada-Afberta Job Grant
Application Form
8. Each party shall give the other party notice in writing of any change in address
9. The Minister's representative for the administration of the Agreement is any person designated by the Minister.
10. This Agreement shall not be assigned by the Employer without the prior written consent of the Minister.
11. This Agreement embodies the entire Agreement between the parties with regard to the matters dealt with herein, and no verbal or
written agreements exist between the parties except as set out in this Agreement.
12 This Agreement is binding upon the parties' successors and assignees
13. This Agreement is governed by and is to be construed in accordance with the laws of the Province of Alberta. The parties to this
Agreement hereby irrevocably and unconditionally attorn to the exclusive jurisdiction of the courts of the Province of Alberta.
Declaration and Authorization of Employer's Authorized Signing Official

By signing and submitting this form. I confirm that I am the Employer's authorized signing official and that:
1 I understand that my personal information may be disclosed to an authonzed employee agent or contractor of the Government o f
Alberta or the Government o f Canada to assist in determining my eligibility for training and employment programs and services:
to monitor, assess and evaluate the effectiveness o f services provided and to evaluate the results o f provincial and federal
programs
2. I have provided true, complete and correct information in this application
3. I understand training cannot be paid for before signing and dating the application form.
4. By signing this application. I acknowledge that I have read and agree to be bound by the attached Canada-Alberta Job Grant
Terms and Conditions
5 I acknowledge that the Canada-Alberta Job Grant Program may decline this application if I have submitted any false information
or concealed a relevant or significant fact Both constitute misrepresentation and I will be required to repay any grant funds
received
6 I acknowledge that I am responsible for notifying the Canada-Alberta Job Grant program immediately o f any change to the status
o f the training or employment of the Trainee, which includes, but is not limited to. resignation, layoff or termination
7. I understand that employees registered and attending an employment and training program funded by the Canada-Alberta Job
Grant will not be deemed to be a worker o f the Government o f Alberta. Trainees in which an employment relationship does not
exist will be deemed to be workers o f the Government of Alberta for the sole purpose o f receiving workers' compensation
benefits tinder the Workers' Compensation Act
8 I understand that this application is not approved until it has been signed by the Minister
(Please submit an original signature Photocopies cannot be accepted)
Date (yyyy-mm-dd) Print Name Title Signature
Office Use Only

HER MAJESTY THE QUEEN IN RIGHT OF ALBERTA, as represented by the Minister of Jobs. Skills. Training and Labour
Per
CJG0001 (2015/08) Page 5 of 5
Page 6
ACTION C anada-A lberta Job G rant Training
♦PLAN,
Government Reimbursement
the Government of Alberta Grant Disclosure Portal
Personal information provided to the Government of Alberta is collected, disclosed and retained under the authority of the Freedom o f
Information and Privacy A ct If you have any questions about the collection of personal information, please contact 1-855-638-9424.
Instructions
t Save the completed form to your hard drive.
• Print the form, ensure all signatures are completed, attach receipts from training providers, and mail it to:

Edmonton, AB
T5J 2L4
form.

Legal Entity Name: Reference Number on Approval Letter:
Part B - Trainee Information

Social Insurance Number (SIN): Legal First Name: Legal Middle Name Legal Last Name:
Part C - Receipts For Training Costs

Attach Original Receipts From Training Provider to This Form
Training Provider
Training Provider Name:
Training Cost
Eligible training costs are limited to:
« Tuition fees or fees charged by the training provider
« Mandatory student fees
* Textbooks, software, and other required materials
* Examination fees
Original receipts from the training provider must be attached to this form. Enter total costs for all Trainees in this section, including GST that
will not be claimed on the Employer's GST returns. All amounts must be in Canadian Dollars.________________________________ _
Number of Trainees: Tuition or Instructional Fees: Mandatory Student Fees:
l
Textbooks, Software, and Other Required Materials: Examination Fees Total Training Costs:
$ 0 .0 0
Government Contribution (2/3 of total training costs): Government Contribution per Trainee
$ 0 .0 0 $ 0 .0 0
CJG0002 (2015/08) Page 1 of 3
Page 7
• Amounts entered for training costs must match receipts submitted
• Employers must contribute a minimum of 1/3 of the total training costs. A maximum o f 2/3 of the eligible Training Costs may be
reimbursed by the Minister if the Employer's Canada-Alberta Job Grant is approved, and such payment will occur in the following
manner 50% of the Grant will be provided to the Employer upon the Minister's approval of this form, and the remaining 50% of the
Grant will be provided to the Employer upon the Minister's approval of the Canada-Alberta Job Grant Training Completion Form
The Minister's maximum contribution towards training costs is $10,000 per trainee.
• Employers cannot claim for GST that is to be refunded by the Canada Revenue Agency.

By signing and submitting this form. I confirm that I am the Employer's authorized signing official and that:
1. I understand that my persona/ information may be disclosed to an authorized employee, agent or contractor of the Government o f
Alberta o r the Government o f Canada to assist in determining my eligibility for training and employment programs and services: to
monitor, assess and evaluate the effectiveness o f services provided and to evaluate the results o f provincial and federal programs.
2. I have provided true, complete and correct information in this application.
3. By signing this application. I acknowledge that I have read and agree to be bound by the attached Canada-Alberta Job Grant
Terms and Conditions as ouf//ned in the Canada-Alberta Job Grant Application form.
4. I acknowledge that the Canada-Alberta Job Grant Program may decline this appticatbn if I have submitted any false information
or concealed a relevant o r significant fact. Both constitute misrepresentation and I will be required to repay any grant funds
received.
5. I acknowledge that I am responsible for notifying the Canada-Alberta Job Grant program immediately o f any change to the status
o f the training o r employment o f the Trainee, which includes, but is not limited to, resignation, layoff or termination.
6 I understand that employees registered and attending an employment and training program funded by the Canada-Alberta Job
Grant will not be deemed to be a worker o f the Government o f Alberta. Trainees in which an employment relationship does not
exist will be deemed to be workers of the Government of Alberta for the sole purpose o f receiving workers' compensation benefits
under the Workers' Compensation Act.
7. I understand that this application is not approved until it has been signed by the Minister
8 I understand training cannot be paid for before signing and dating the application form
Per: (Please submit an original signature. Photocopies cannot be accepted)
Date (yyyy-mm-dd} Print Name Title Signature
Office Use Only
Date (yyyy-mm-ddi Amount Approved Signature
Page 8
Part D - Direct Deposit Form
The information indicated on this form is confidential and will be used solely for the purpose of depositing your payments directly into your bank account
We will not release this information tor any other purpose If you have any questions or concerns, please contact 1-855-636-9424
Completion of All Fields is Mandatory. Incomplete forms will not be processed.
INSTRUCTIONS
- This form is not required if you have a Legal Entity voided cheque
- Funds will only be deposited in the company name
- This form must be signed by an official representative of the Bank
- This form must contain the "Bank Stamp".
Have you already submitted payment information on a previous reimbursement application? Q Yes Q No
O Parti
Party Authorized to Receive Payment Vendor Number (if known)
See sample cheque below to complete the following information;
A. Name of Account Holder
Last Name/Company Name First Name Middle Name
Address City/Town
Province Postal Code feiephone Number (include area code)
OPT IN - Vendor email address for electronic remittance advice
□ OPT OUT (with a check box) will not receive electronic delivery of remittance advice.
rTauthorize the Province of Alberta to make all payments due to me by deposit to the above account Payment shall continue until I advise
you of any change.
LQ Part 2
Dated Signed Dated Signed (if joint account)
'J
Bank Information
B. Name of Bank C. Bank Address
Type of Account (please check one): D. Bank Transit/Branch Number E. Bank Number F. Account Number
Q Chequing Q Savings
Print Name of Financial Institution Officer Telephone Number 1Dated Financial Institution Officer's Signature
*107. 12271. MESted

Ejtmxton. A tw ti T6P n.t
Sample of Cheque
:me _
_________ i_________
159
r Bank Teller Stamp
1
*____ J
____________ __________ UdM
OF Z U IU U
■ S*- • W S n* I 107 k jfn u t
I v- ww 'orsrcttr
I 'm Atriad ICWJN’O A iU Tj*3Pa ------------ -----------------
- i d - l e m r e o t d i - t - u — ___________ ________________________
____ „ II
?
0
t
E
~
I
? im R j Av a.
L
r. rafcr 4
j ( ew o c o e tiw r i
h i- tf ■ .•«»*•■ » M< T > J H
J
Please return with your reimbursement form.
CJG0002 (2015/08) Page 3 of 3
Page 9
Canada J m *j>sh, Government
C anada-A lberta
Job G rant Training Com pletion
The personal Information you provide on this form is being collected by the Government o f Alberta to determine eligibility for the Canada
federal programs Upon approval of a grant application, the grant recipient the grant program and the grant amount may be published on
the Government of Alberta Grant Disclosure Portal
Personal information provided to the Government of Alberta is collected, disclosed and retained under the authority of the Freedom of
Information and Privacy Act. If you have any questions about the collection of personal information, please contact: 1-855-638-9424
Instructions
• Print the form, sign it. and mail it within 30 days of training completion to

P 0 Box 840 Edmonton Mam
Edmonton. AB
T5J 2L4
form.

Legal Entity Name Reference Number on Approval Letter
Pavt B • Employer Satisfaction

Please indicate using a scale of 1 to 5, where 1 is 'Strongly Disagree'. 2 is "Disagree". 3 is "Neither agree nor disagree", 4 is ' Agree'’, and 5
is “Strongly Agree," if you agree with the following statements. Please check the appropriate number.
The Canada-Alberta Job Grant processes were easy to follow □ ' Q 2 Q 3 0 * □ 5

The time between submission of my application and its approval was acceptable □ ' Q 2 0 3 □ « Q 5
The training received by the Trainee met my training needs □ ' Q 2 Q 3 Q * □ *
The skills acquired by the Trainee met my business needs O ' l ]2 □ 3 Q * Q 5
Part C - Training Outcome____________ _______ _______ ________________________________

Did all approved Trainees attend/complete the approved Training Courses'? □ Yes □ No
If no', please provide the information requested below
Did you receive a refund from the training provider for those Trainees who did not attend/complete the Training Courses'? 0 Yes Q No
I If yes', what was the total amount of the refund?
Please provide the following information for each Trainee who did not attend/complete any approved Training Cojrse.
Social Insurance Number (SIN) Legal First Name. Legal Middle Name Legal Last Name
Course Title:
[ J Trainee did not attend tra nmg course [ j Trainee did not complete training course
Reason Trainee did not Attend/Compiete'
Add TraineefTraining Course Remove Trainee/Training Course
CJG0003 (2015/08) Page 1 o f2

Part D - Changes to the Approved Training Program
Course Dates
__
Did the dates change for any Training Course since the application approval? Q Yes □ No
I f ‘yes' please provide the following information for each Training Course with different dates than those indicated in the application
T
Course Title i Start Date iy/yy-mm-tsci End Date (yyyy-mm-cofj
J
1 Add Course Remove Course
Number of Training Hours
Did the number of hours of training per Trainee change for any Training Course since the application approval? □ Yes [ J No
If yes' please provide the following information for each Training Course with a different number of hours of training per Trainee than
indicated in the application
Course Title Hours of Training Per Trainee
Add Course Remove Course

The whole amount of the grant proceeds shall only be used for the purpose described in the Canada-Alberta Job Grant Program,
and in accordance with the requirements of the Government Organization A ct and the Employment and Immigration Grant
Regulation, as amended.

By signing and submitting this form. I confirm that I am the Employer’s authorized signing official and that
1 I understand that m y persona/ information may be disclosed to an authorized employee agent or contractor o f the Government o f
Alberta or the Government o f Canada to assrsf in determining my eligibility for training and employment pregrams and services, to
monitor, assess and evaluate the effectiveness o f services provided and to evaluate the results of provincial and federal programs
3 By signing this application, t acknowledge that I have read and agree to be bound by the attached Canada-Alberta Job Grant
Terms and Conditions as outlined in the Canada-Alberta Job Grant Application form .
4 I acknowledge that the Canada-Alberta Job Grant Program may decline this application tf t have submitted any false information
or concealed a relevant o r significant fact Both constitute misrepresentation and I wtil be required to repay any grant funds
received
5 I acknowledge that I am responsible for notifying the Canada-Alberta Job Grant program immediately of a ry change to the status
o f the training o r employment o f the Trainee, which includes, but is not limited to. resignation. layoff or termination.
6 I understand that employees registered and attending an employment and training program funded by the Canada-Alberta Job
Grant will not be deemed to be a worker o f the Government o f Alberta Trainees in which an employment relationship does not
exist will be deemed to be workers of the Government of Alberta for the sole purpose o f receiving workers' compensation benefits
under the Workers’ Compensation Act
7. I understand that this application is not approved until it has been signed by the Minister
Per (Please submit an original signature Photocopies cannot be accepted J
Office Use Only

i
Date (yyyymm-ddi Amount Approved Signature
Page 11
Canada -4 m ** Government
Trainee information
Job Grant Program. If you choose to apply, the personal information you provide will be used in the application process, for ongoing
the Government of Alberta Grant Disclosure Portal.
Personal information provided to the Government of Alberta is collected, disclosed and retained under the authority of the Freedom of
Information and Privacy Act If you have any questions about the collection of personal information, please contact: 1-855-638-9424.
Instructions
This form is to be filled out and signed by the trainee. The information provided forms part of the Canada-Alberta Job Grant Application and
will be used by the Government of Alberta to determine eligibility for the Canada-Alberta Job Grant Program,
• Print the form, sign it, and attach it to the Canada-Alberta Job Grant Application form.
• Refer to the Applicant Guide available on the Canada-Alberta Job Grant website for assistance in completing this form.
Employer Name:
Social Insurance Number (SIN): If you have a SIN that begins with (he number 9. p/ease submit a copy ofyour work and studypermits
Legal First Name: Legal Middle Name: Legal Last Name:
Date of Birth (yyyy-mm-dd) Mailing Address:
City. Province: Postal Code: Home Phone Number Cell Phone Number:
Alberta
Occupation/Job Title: NOC (Admin use only:)
Job Description:
Are you legally entitled to work in Canada?
□ Yes □ No
Demographic hriMmation:
Gender: Employment Status Prior to Training:
] Male 0 Female 0 Other 0 Unemployed 0 Employed 0 Self-Employed

Status in Canada:
0 Canadian Citizen 0 Permanent Resident 0 Protected Person under the Immigration and Refugee Protection Act (Canada)
0 Other
Designated Groups - Select all that apply: (optional)
0 Aboriginal 0 Recent Immigrant (Resided in Canada for 5 years or less) 0 Immigrant (Resided in Canada for more than 5 years)
] Person with Disability
CJG10914 (2015/08) Page 1 of 2
Page 12
Highest Level of Education Completed:
□ Less than High School Q High School □ Some Post-Secondary □ Trades Certificate or Diploma [ J Diploma
□ University Degree
El Claim information:
As a general rule, to be entitled to regular Employment Insurance benefits, individuals must show that they are unemployed, able and
willing to work and actively looking for suitable work. Therefore, if taking a full-time training course funded under the Canada-Alberta Job
Grant, without being directed to do so by a designated authority, you must show, without a doubt, that taking a course is not an obstacle to
your active job search or acceptance of appropriate employment, tn order to be able to continue to collect benefits while attending training,
you will require a referral to full-time training, For active regular benefit recipients, the information provided on this form will be used to
contact you and discuss your training plans and the potential impact to your benefits
Do you currently have an Employment Insurance (El) claim If yes. what type of claim;
established?
□ Yes □ No ] Regular □ Medical Q Maternity Q Parental Q Compassionate
Have you recently applied, or plan to apply for El benefits?
□ Yes □ No
Have you received EJ benefits in the past 3 years?
□ Yes □ No
Have you received maternity or parental benefits in the last 5 years?
□ Yes □ No
I understand that as a trainee in which an employment relationship does not exist, while I am registered and attending an employment and
training program funded by the Canada-Alberta Job Grant, I will be deemed to be a worker of the Government of Alberta for the sole
purpose of receiving workers’ compensation benefits under the Workers’ Compensation Act. if injured in an accident, I will be entitled to
claim workers' compensation benefits and have resigned my right to take legal action against Jobs, Skills, Training and Labour, the
Government of Alberta, and any other employer or worker covered by the Workers' Compensation Act.
If the above is not applicable. I understand that as an employee registered and attending an employment and training program funded by
the Canada-Alberta Job Grant, I will not be deemed to be a worker of the Government of Alberta.
{Please submit an original signature. Photocopies cannot be accepted)
Date (yyyy-mm-dd) Trainee Name fp/ease print) Title Trainee Signature
CJG10914 (2015/08) Page 2 of 2
Page 13
Government Notice to Minister of Group Terminations
Employment Standards
The information you provide is collected and managed pursuant to the Freedom of Information and Protection of Privacy
Act and the Employment Standards Code, If you have any questions about the collection of information, please contact
the Director, Employment Standards at 780-415-0590 or toll-free at 310-0000.
The Employment Standards Code, section 137, requires employers to give the Minister four weeks' written notice of
intent to terminate 50 or more employees at a single location within a 4-week period. This notice provides the
Government of Alberta with important labour market information and enables it to mobilize workforce supports. A written
acknowledgement of this notice will be sent to the employer address below.
Please fill out this form completely.
Employer name
Employer address Cily Postal Code
Employer mailing address (if different than above) City Postal Code
Work location (if different from employer address)
Employer contact Employer phone number
Number of employees being terminated Effective date of termination fyyyy-mm-dd)
Reason(s) for termination of employment:
Services and benefits being provided to terminated employees:
Additional information:
Name of individual completing this form Contact phone number Date (yyyy-mm-dd)
Send this completed form to: Employment Standards Program Delivery

Alberta Jobs, Skills, Training and Labour
7 0 1 ,7th Floor, Labour Building
10808-99 Avenue
Edmonton, AB T5K 0G5
Fax: 780-422-5424
Email: jstl.esnotice@qov.ab.ca
ES00G1 (2015/09) Page 1 of 1
Page 14
Governm ent Employee Self Help Kit
The Self Help Kit provides you and your employer with information on basic employee/employer rights and
responsibilities in the workplace. If you have not received your proper earnings, you may write a letter or use
the Request for Payment form to ask your employer for your pay. Using this Self Help Kit may help you resolve
the problem on your own.
Do not use the Self Help Kit if:
• Your employment ended more than five months ago. You should complete the Complaint by
Employee form as soon as possible, as complaints must be filed within six months of the last day of
work.
• The business is closed.
• The pay cheque you received was returned NSF.
Whether you write your own letter or use the Request for Payment form, include the following important
information:
• Describe what your claim is for (wages, overtime, vacation pay, etc.)
• How much is owed and why.
• Tell the employer that if the dispute is not resolved, you may file a complaint with Employment
Standards.
• Copies of any Employment Standards information relevant to your dispute.
• The Letter from Employment Standards to the Employer, the Complaint Resolution Process fact
sheet, and the Employment Standards Guide.
Date and sign your letter, ensuring your name and address are included.
If your attempt to resolve the dispute is not successful, you will need to complete the Complaint by Employee
form and send it to Employment Standards.
You must file a complaint with Employment Standards within six months of your last day of
employment.
if you have questions about the Self Help Kit, call Employment Standards at 780427-3731 in Edmonton, or
toll free in Canada at 1-877427-3731, or visit www.employment.alberta.ca/es
ES0799 (2010/02)
Page 15
Request for Payment
Name and Address

From: Dale (mm/dd/yyyy)
Your Name Date
Your Address
Employee Phone Number:
________ Your phone no.
Name and Address of Employer
To: Employer Phone Number:
Employer's Name, Attention: Employer's phone no.
Employer's Address
According to the Employment Standards Code, I believe I am entitled to the following:
Wages From Wages To Number of Hours Rate of Pay Amount Owing

(mm/dd/yyyy) (mm/dd/yyyy)
January 2,2010 January 15,2010 $9.00 J792.00
Overtime From Overtime To Number of Hours Rate of Pay Amount Owing

January 2,2010 January 15,2010 8 $13.50 $108.00
From; (mm/dd/yyyy) To: (mm/dd/yyyy)

Vacation Pay %8500.00 x * % 340.00
March 1,2009 January 15, 2010
Genera! labour Day • September 7, 2009 (Average Daily Wage) $ 72.00

Holiday Pay
(list specific days) Thanksgiving Day • October 12,2009 (Average Daily Wage) $ 72.00
Time and one half for hours worked on October 12,2009 (8 hours x $13.50) $ fO8.00
Total General Holiday Pay > $ 252.00
Termination Pay Period of Employment: 10 Months (1 week pay in lieu of notice) s 395.00
Other
(Please explain) Unauthorized deduction for cell phone bill taken off final pay cheque $ 52.00
Total Owing: $ 1940.00
am requesting payment in the amount of S 1940.00
Please respond to this request within 10 days. If you fail to respond, or if we are unable to resolve this matter, I may file
a complaint with Employment Standards.
Sincerely,
Your Signature
ES0799 (2010/02)
Page 16
Request for Payment
Name and Address

From: Date (mm/dd/yyyy)

To: Employer Phone Number:


From: (mmWyyyyj To: (mm/dd/yyyy)

Vacation Pay S X % =: |$
General | $.
Holiday Pay
(List specific days) $
Total General Holiday Pay . S
Termination Pay $
Other
|
(Please explain) $
lS
Total Owing: > s

I am requesting payment in the amount of $
Please respond to this request within 10 days. If you fail to respond, or if we are unable to resolve this matter, I may file
Sincerely,
ES0799 (2010/02)
Page 17
Request for Payment
Name and Address

From: Date (mm/dd/yyyy)

To; Employer Phone Number:


From; {mm/dd/yyyy) To; (mm/dd/yyyy)

Vacation Pay |s x % -
$
General |s ^
Holiday Pay
(List specific days) s
Total General Holiday Pay > $
Termination Pay s
Other
(Please explain) $
Total Owing: !
am requesting payment in the amount of S
Please respond to this request within 10 days. If you fail to respond, or if we are unable lo resolve this matter, I may file
Sincerely,
ES0799 (2010/02)
Page 18
G o v e rn m e n t Letter from Employment Standards to the Employer
Attached is a letter from a current or former employee of your company requesting payment of outstanding
earnings they believe are due under the Employment Standards Code. The employee has been asked to
enclose an Employment Standards Complaint Resolution Fact Sheet, an Employment Standards Guide and
other information related to their concern(s). This information provides an overview of the minimum standards
established by the Employment Standards Code and Regulation and describes the complaint resolution
process. Employment Standards encourages employers and employees to resolve their disputes without direct
government intervention. If you are unable to resolve the matter, your employee may file a complaint with
Employment Standards. The complaint will then be assigned to an Employment Standards Officer for
investigation,
If you have any questions about minimum standards of employment, or if you need further clarification on the
complaint resolution process, you may contact Employment Standards by calling 780-427-3731 in Edmonton
or toll free in Canada by dialing 1-877-427-3731, or visit our website at www.employment.alberta.ca/es
If, as a result of your review of this matter, you determine that your business practices are not in compliance
with minimum standards, please take immediate steps to ensure you correct the situation for all employees.
ES0799 (2010/02)
Page 19
Government Letter from Employment Standards to the Employer
Attached is a letter from a current or former employee of your company requesting payment of outstanding
earnings they believe are due under the Employment Standards Code, The employee has been asked to
enclose an Employment Standards Complaint Resolution Fact Sheet, an Employment Standards Guide and
other information related to their concern(s). This information provides an overview of the minimum standards
established by the Employment Standards Code and Regulation and describes the complaint resolution
process. Employment Standards encourages employers and employees to resolve their disputes without direct
government intervention. If you are unable to resolve the matter, your employee may file a complaint with
Employment Standards. The complaint will then be assigned to an Employment Standards Officer for
investigation.
If you have any questions about minimum standards of employment, or if you need further clarification on the
complaint resolution process, you may contact Employment Standards by calling 780-427-3731 in Edmonton
or toll free in Canada by dialing 1-877-427-3731, or visit our website at www.employment.alberta.ca/es
If. as a result of your review of this matter, you determine that your business practices are not in compliance
with minimum standards, please take immediate steps to ensure you correct the situation for all employees.
ES0799 (2010/02)
Page 20
A dobe Reader 7.1+ is required to com plete and save th is d ocum e n t
Government Filing a Confidential Complaint

of Alberta ■ with Employment Standards
The Employment Standards Code and Employment Standards Regulation establish minimum standards of employment
for most employers and employees working in Alberta. Employment Standards assists employees and employers to
resolve differences concerning the interpretation, application and enforcement of these standards.
The minimum standards include em ploym ent records, hours o f work and overtime, payment of wages, overtime, general
holiday pay, vacation pay. maternity and parental leave, termination of employment and employment of adolescents and
young persons. Confidential complaints about maternity and parental leave and termination of employment are not
accepted, as the issues cannot be resolved without naming the employee.
Can an employee who is currently employed with an employer file a complaint and request their name
be held in confidence?
Yes. Employment Standards will accept the complaint and attempt to resolve the matter without giving the employer the
name of the employee. Personal information is collected under the provisions of the Freedom of Information and
Protection of Privacy Act An employer may be able to determine the employee’s identity through other methods,
information or third parties
Is there a time limit for filing a confidential complaint?
A confidential complaint may be made at any time while the employee is employed by the employer.
How do I file a confidential complaint?
A confidential complaint must be made in writing and must be signed. Deliver the completed Confidential Complaint by a
Current Employee form to an Employment Standards office Attach to your complaint form any documents that may help
with the investigation.
What actions will Employment Standards take when a confidential complaint is filed?
The confidential complaint will be assigned to an Employment Standards officer for investigation. The officer will contact
the employer and address the alleged contravention. The name of the individual who filed the complaint will not be
provided to the employer. If a contravention of minimum standards is identified, the employer will be informed of the
requirements of the legislation and be required to correct the situation. If the employer refuses to correct the situation from
that day forward, the officer will follow up with the employer. The officer will notify the complainant of the outcome of the
investigation and ask the individual to contact the officer if the matters brought to the employer's attention are not rectified
Can an employee change their confidential complaint to a regular complaint and request enforcement
of earnings?
Yes. If an employee waives confidentiality at a later date, payment of earnings may be enforceable The employee will be
required to complete and sign the regular Complaint by Employee form Regular complaints must be filed within 6 months
of the last day of employment.
Once the form is completed and documentation attached:
1. Retain a copy of the Confidential Complaint by a Current Employee form and attachments for your records.
2. Deliver the completed form to an Employment Standards office.
ES3532 (2009/10) Page 1 of 5
Page 21
Government
of Alberta ■ Confidential Complaint by a Current Employee
The information you provide on this form, and any other information you provide to Employment Standards relating to this complaint, is
collected under the authority of the Alberta Employment Standards Code and the Freedom of Information and Protection of Privacy
(FOIP) Act and will be used for the purpose of conducting an investigation into your complaint Your personal information is managed
in compliance with the FOIP A c t . If you have any questions about how your personal information is handled, you may contact
Employment Standards by calling 780-427-3731 in Edmonton or toll free from anywhere in Alberta by dialing 1-877-427-3731, or visit
www,emplovment.alberia.ca/es
Employee
First Name Middle Name Last Name Birlhdate (yyyy/mm/ddi
Home Address Alternate Address
City Province Postal Code City Province Postal Code
Telephone Number Fax Number Alternate Telephone Numbers
Business Number Cell Number Email Business Number
Employer
Legal Name Business Name
Mailing Address Address ol Worksite
City Province Postal Code City Province Postal Code
Telephone Number Fax Number Cell Number Email/Website
Nature of Business Name of Manager/Supervisor
Employment Information
Job Title Date Employment Commenced (mm/dd/yyyy!
Do you have records of ■Are you still employed by if no. please use (he regular Complaint by
hours worked? (If yes, | the employer named .v n w Employee form
attach originals) □ □ N° above9 U Yes U N°
Are you covered by a
If yes. state particulars
collective agreement or _
employment contract? L_Mes L i 0
Complaint Information
Claim refers to r ] W39es ^M inim um Wage
[ j Overtime Unauthorized Deductions
Q ] Vacation Pay [^ O th e r
[^G en eral Holiday Pay Q Other
Continued on next page...

ES3532 (2009/10) Page 2 of 5
Page 22
Confidential Complaint by a Current Employee
Provide details about your complaint (refer to tip Sheet)
Declaration and Signature
• I certify the information submitted is true and complete to the best of my knowledge,
• I understand that there will be no monetary assessment as a result of this complaint.
• For the purpose of investigating and resolving this complaint, I understand that information concerning the issues
of my complaint will be disclosed to the employer. I understand that Employment Standards will attempt to resolve
the complaint without revealing my identity. I recognize that the employer may determine my identity through
other methods, information or third parties.
• I will notify Employment Standards of any change to my address or phone number,

Signature of Employee Date imm/(kt/yyyy)
Office Use Only

Received by Claim Number Date (mm/dd/yyyy)
Q Mail [^Interview
ES3532 (2009/10) Page 3 of 5
Page 23
Government Tip Sheet for a Confidential
of Alberta ■ Complaint bv a Current Employee
Employee Information
Name of Employee - Provide full legal name (no initials).
Date of Birth - Provide 4 digits for year, 2 digits for month and 2 digits for day
Address - Provide full mailing address and postal code
Alternate Address - Provide an alternate address and postal code where you can be reached if Employment
Standards cannot reach you at your current address.
Telephone Number - Provide telephone, fax and cell numbers to allow us to contact you.
Alternate Telephone Number - Provide a telephone number where a message may be left during business
hours if Employment Standards is unable to contact you.
Legal Name - Provide the full legal name, e g. Bruck Holdings (1981) Limited. In the case of a proprietorship,
show the owner’s full first and last name
Business Name - Provide the operating name of the employer, e g, Blueberry Hotel
Mailing Address - Provide full address of the employer. NOTE; In the event the employer does not have an
address, or you are unsure of the address, please attach a sketch to the claim form indicating
directions.
Address of Work Site - Provide the address of where the work was performed
Telephone Number - Provide the employer's business number, and if possible, the fax number, residential
number, cell phone number, and e-mail address
Nature of Business - Provide the exact type of business, e g. restaurant, trucking, construction, etc.
Name of Manager/Supervisor - Provide the name and position of your manager/supervisor.
Employment Information
Job Title - Provide details of your position, e g. waitress, truck driver, baker.
Date Employment Commenced - Provide the date on which you started work for the employer,
Do You Have Records of Hours Worked? - Attach the originals to the complaint form
Still Employed by Above Employer? - If you are no longer employed, use the regular Complaint by Employee
form
Are you Covered by a Collective Agreement or Employment Contract? - If so. provide the name and
address o f the Union or
Association, and/or a copy of the
written contract or agreement
ES3532 (2009/10) Page 4 of 5
Page 24
Tip Sheet for a Confidential Complaint by a Current Employee (continued)
If you require further assistance in completing the confidential complaint form:
* Call Employment Standards at 780-427-3731 in Edmonton or toll free from anywhere in Alberta by dialing
1-877-427-3731,
* For the deaf or hard of hearing with TDD/TDY units, in Edmonton call 780-427-9999 or toll free from
anywhere in Alberta by dailing 1-800-232-7215.
Attention: Sign and date the completed Confidential Complaint by a Current Employee form
and mail it with any supporting documents to the nearest complaint processing office listed
below. Keep a copy for your records.
Calgary Edmonton Lethbridge Red Deer
Suite 150 Main floor Room 360 Room 209

Elveden Centre Sterling Place Provincial Building Provincial Building
717-7 Avenue SW 9940-106 Street NW 200-5 Avenue South 4920-51 Street
Calgary, AB Edmonton, AB Lethbridge, AB Red Deer, AB
T2P 0Z3 T5K2N2 T1J4L1 T4N 6K8
Employment Standards Website:

www.employment.alberta.ca/es
ES3532 (2009/10) Page 5 of 5
Page 25
O FFIC IA L RECEIPT Receipt No.
Government
AC 985122
Amount Date (yyyy-mm-dcjj

Cash Q Cheque Q Money Order
GST Exemption Number R124072513
RECEIVED FROM: Name and Address of Payee
Description:
Government of Alberta as per
Jobs, Skills, Training and Labour

Department Name
JSTL10928 (2015/05) 1 - Applicant's Copy
Page 26
J % [b e *b c u i Government Employer Application Form A
Summ er Temporary Employment Program (STEP)
The information you provide, including personal information, is being collected by the Government of Alberta to determine eligibility for potential funding
related to the Summer Temporary Employment Program (STEP) offered by the Government of Alberta under the Workforce Strategies Division. By choosing
to apply, the information you provide may also be used to monitor, assess and evaluate the effectiveness of services provided and to evaluate the results of
the program. The information you provide may also be used to assist the Government of Alberta in planning, delivering and enhancing programs and
services offered by the Workforce Strategies Division. On approval of a grant application, the grant recipient (the employer), the grant program and the grant
amount may be published on the Government of Alberta Grant Disclosure portal.
Personal information, including payroll information, is collected pursuant to the Freedom of Information and Protection of Privacy Act and will be managed in
accordance with the privacy provisions in the Act If you have any questions about the collection of personal information, please contact the Summer
Temporary Employment Program at 780-638-4727 or 1-866-338-4727, by mail at Summer Temporary Employment Program, P.O. Box 1016, Edmonton
Main. Edmonton AB, T5J 2M1 or by email at: step@oov.ab.ca,
Instructions
• Complete the form electronically.

• Print the form, sign it, and mail it to:
Summer Temporary Employment Program
Ministry of Labour
Edmonton, AB
T5J 2M1
Refer to the Employer Guidelines available at.
www.AlbertaCanada.com/STEP for assistance in completing this form.
Reference Number (for staff use on//)
Type of Employer:
Legal Entity Name:
Employer Operating Name:
Mailing Address of Business/Organization:
City/T own/MunicipaMy: Province/Territory Postal Code
Telephone Number; Fax Number.
Company Web Site Address (if availabley. Email Address:
Is the Organization/Business address where the participant will be working different from the above mailing address? Q Yes Q No
Organization/Business Address where participant will be working (if different from mailing addressy.
City/T own/Municipality: Province/Territory Postal Code

Alberta
Telephone Number: Fax Number:
Primary Sector your business/organization operates in (Se/ecf only one)'. (Please refer to the North American Industry Classification Svstemj
JSTL11101 (2016/02) Page 1 of 3
Page 27
Employer Contact
First Name: Last Name:
Position/Title: Telephone Number: Alternate Telephone Number:
Email Address:
Position Information
Total number of STEP positions you are applying for:
If you are applying for more than one STEP position, will any of these positions have different job titles and descriptions’ Q Yes Q No
If yes, number of different job titles and descriptions you are applying for?
Job Details - If you are requesting STEP funding for one or multiple positions for the same job title and description, you will
only need to fill out this section once.
If you are applying for positions with different job titles and descriptions, this section will need to be completed for each
different job title and description.
Job Details Section # 1
Job Title: NOC (Admin use only)
Job Description:
Number of placements requested for this Job Title?

Job Anticipated Anticipated Anticipated Anticipated Anticipated Estimated Estimated Estimated
Title Start Date End Date number of hours of work hourly wage Total Cost of Em ployer Cost Governm ent Cost
# days the per day paid to Placement of Placem ent of Placem ent
participant participant (based on a
will work $7 00/hr subsidy)
during the
The estimated costs below are automatically calculated
placement
$ 0.00 $ 0.00 $ 0 .0 0
Employer Details
Does your business/organization currently offer internship or co-op placement programs? □ Yes □ No
If yes, will this funding be used to fill one o f those positions? □ Yes □ No
Will any of the hired participants displace or reduce the work hours of existing employees? □ Yes Q No
Is this position filling a: If the position is filling a vacant position, how long has the position been vacant?
Page 28
Employer Declaration
By signing and submitting this form, I confirm that I am the employer’s authorized signing official and that;
1. The information contained in this Application, including personal information, may be disclosed to an authorized
employee, agent or contractor of the Government of Alberta to assist in determining eligibility for the STEP program; to
monitor, assess and evaluate the effectiveness of services provided and to evaluate the results of provincial programs.
3. I have read the STEP Guidelines and the Employer will be bound by them.
4. If any false information is submitted or any relevant or significant fact is concealed, both of which constitute
misrepresentation, the Minister may decline the Em ployer’s application and may require the Employer to repay any
grant funds received.
5. The Employer is responsible for notifying the STEP Program immediately of any change to the status of the
employment of the participant, which includes, but is not limited to, resignation, layoff or termination.
6. Any employee whose wages are subsidized by STEP will not be deemed to be a worker of the Governm ent of Alberta.
7. This application is not approved until it has been signed by the Minister.
Signing Authority Name Position/Title
Date (yyyy-mm-dd) Signing Authority Signature
Office Use Only
Amount Approved Date (yyyy-mm-dd) Print Name Signature
JSTL11101 (2016/02) Page 3 of 3
Page 29
STEP S tudent H iring A pplication (Form B)
Summ er Temporary Employment Program
The information you provide, including personal information, is being collected by the Government of Alberta to determine eligibility for potential funding
related to the Summer Temporary Employment Program (STEP) offered by the Government of Alberta under the Workforce Strategies Division. By choosing
to apply, the information you provide may also be used to monitor, assess and evaluate the effectiveness of services provided and to evaluate the results of
the program. The information you provide may also be used to assist the Government of Alberta in planning, delivering and enhancing programs and
services offered by the Workforce Strategies Division, On approval of a grant application, the grant recipient {the employer), the grant program and the grant
amount may be published on the Government of Alberta Grant Disclosure portal.
Personal Information, including payroll information, is collected pursuant to the Freedom of Information and Protection of Privacy Act and will be managed in
accordance with the privacy provisions in the Act. If you have any questions about the collection of personal information, please contact the Summer
Temporary Employment Program at 780-638-4727 or 1-866-338-4727. by mail at Summer Temporary Employment Program, P.0 Sox 1016. Edmonton
Main, Edmonton AB. T5J 2M1 or by email a tslep@aov.ab.ca.
Instructions
• Complete the form electronically. • Print the form, sign it, and mail it to:
• Submit with signed Gram Agreement. S “ (timer Temporary Employment Program
Ministry of Labour
• Refer to the Employer Guidelines available at: ^ ® Box 1016 Edmonton Main
www.AlbertaCanada com/STEP for assistance in Edmonton. AB T5J 2M1
completing this form
JSTL11102 (2016/02) Page 1 of 3
Page 30
Student Applicant information continued
Do you currently live in Alberta? G Yes QNo
Are you 15 years or older from the start date of your placement? GYes QNo
Did you attend high school or a post-secondary education program this past academic year? GYes
Are you returning to school this fall before November 1st? D Yes D ^°
Status in Canada.
Q C anadian Citizen G Perm anent Resident G ProtectedPerson under the Immigration and Refugee Protection Act (Canada)
G O th e r
Please identify your gen d e r:_____________________________________
Designated Group (optional) G ^ s t Nation G ^o n -S ta tu s Indian G ^ 's G l nuit G ^ erson with Disability
(please check all that apply)
G ^ e c e n t Immigrant (resided in Canada for 5 years or less)
G 'm m ig ra n t (resided in Canada for more than 5 years)

G o tte n (please specify)'
Student Applicant Education History
Current Student Status G * arn a high school student, returning in the fall.
G 1 ann a high school student, entenng a post-secondary institution in the fall.
0 1 am a post-secondary student who will be returning in the fall.

G O th e r (please specify)
If you are attending a post-secondary rjpost-secondary Certificate G P ° s^ secondary D'P'oma

institution in the fall, what type of
program are you enrolled in? GPost-secondary Degree (Applied or Bachelor's) G ^ aster s De9ree
G D octoral Degree
G O th e r (please specify)'
Student Employment History
Employment status this past G Unem ployed, not looking G O nemPl°yed- but looking
academic year while in school,
(please select all that apply): G E m ployed - part time job G EmP|0yed * M time
G E m ployed - multiple jobs G ^ '^ P t o y ^
Q O th e r (please specify):
If you were working this past G l foundit easy to find work

academic year, describe your
experience finding wort* G "fh e re were some difficulties but 1was able to find and keep employment
(please select all that apply):
G l was looking for full time work but was only able to find part time work
P a g G 31
G l was unable to find the type of work that 1was looking for and needed to do something different
Specify your Job Title Avg. No. of Hours worked/week Hourly Wage
By signing and submitting this form, I confirm that:
1, The information contained in this Application, including personal information, may be disclosed to an authorized employee, agent or
contractor of the Government of Alberta to assist in determining eligibility for the STEP program, to monitor, assess and evaluate the
effectiveness of services provided and to evaluate the results of provincial programs.
2 I have provided true, complete and correct information in this application
X
Date (yyyy-mm-dd) Student’s Name (printed) Signature of Student
JSTL111Q2 (2016/02) Page 3 of 3
Page 32
I
STEP G rant A greem ent

Summ er Temporary Employment Program
Instructions
• Complete the form electronically.
• Print the form, sign it, and mail it to:

Summer Temporary Employment Program
Ministry of Labour
Edmonton, AB T5J 2M1
• Submit with completed Student Hiring Application (Form B)
• Refer to the Guidelines available at:

www.AlbertaCanada com/STEP for assistance in
completing this form
Employer Legal Entity Name:
Reference Number
(found on em ployer approval tetter)
Page 33
Reference Number
(found a r t em ployer approval letter)
Government
BETWEEN:
HER MAJESTY THE QUEEN IN RIGHT OF ALBERTA

as represented by the Minister of Labour
(the "Minister”)
and
(the "Recipient")
on
WHEREAS the Recipient has submitted an application for a grant to the Minister;
WHEREAS the M inister is authorized to make grants in accordance with the Em ployment and Immigration Grant Regulation
"Grant Regulation", as amended;
AND WHEREAS the Minister has agreed to make a grant subject to the terms and conditions o f this Agreement;
The M inister and the Recipient therefore agree as follows:
1. THE GRANT
1.1 Upon the signing of this Agreement, the Recipient's STEP Employer Application and Student Hiring Application
(collectively referred to as the Application and forming Schedule A to this Agreement) are approved, subject to the
terms and conditions of this Agreement and the STEP Guidelines,
1.2 Subject to the Legislature of Alberta appropriating sufficient money for the purposes o f this Agreement, and subject to
the term s and conditions o f this Agreem ent and the Recipient's compliance therewith, the M inister will provide a grant
up to the amount described in the Application (the Grant) to the Recipient for the purpose of providing a wage subsidy
as described in the Application (the STEP position).
1.3 The Grant payments will be made as follows
1.3.1 Subject to section 1.3.2, the Grant will be paid within a reasonable time following the Minister's approval of the
STEP Completion Form described in section 2.3.
1.3.2 At the Minister's discretion, the Recipient may request a portion of the Grant be paid within a reasonable time
following the Minister's approval of the STEP Interim Reimbursement Form described in section 2.2.
1.4 The Recipient will use the Grant solely for the STEP position described in the Application, including any modifications
approved by the M inister in writing.
15 The term of this Agreem ent is the period identified in the Application, and includes any extension agreed to by the
Minister.
1.6 Nothing in this Agreem ent in any way relieves the Recipient from strict compliance with the Grant Regulation, or
otherwise, impacts the interpretation or application o f the Grant Regulation.
2. REPORTS, RECORDS AND MONITORING ,Page 34
2.1 All reports m ust contain the information and be in a form at specified by or acceptable to the Minister.
2.4 During the Term and for a period o f two (2) years afterwards, the Recipient will maintain or cause to be maintained full,
accurate and complete records of the activities conducted in furtherance of, and the results achieved through the
conduct of, the STEP position.
2.5 During the Term and for a period of two (2) years afterwards, the Recipient will maintain or cause to be maintained full,
accurate and complete financial records relating to the receipt of and expenditure o f the Grant and other funds received
and expended for the purposes of the STEP position.
2.6 The Recipient, during the Term and for a period of two (2) years afterwards, will produce on demand to any
representatives o f the Minister, or the Auditor General of Alberta, any of the records referred to in section 2.4 and 2.5
and will permit those representatives to examine and audit these records and take copies and extract of them.
2.7 The Recipient acknowledges that this Agreement, including the name of the Recipient, and the terms and conditions of
the Grant under this Agreement, may be subject to disclosure pursuant to the Freedom o f Information and Protection o f
Privacy A ct (FOIP). The Recipient further acknowledges that FOIP applies to information obtained, related, generated,
collect or provided to the M inister under this Agreem ent and that any information in the custody or under the control o f
the Minister may be disclosed.
3. CONFLICT OF INTEREST
3.1 The Recipient will ensure that the Recipient and its employees, directors, officers, contractors and agents:
(a) conduct their duties related to this Agreem ent with impartiality and will disqualify themselves from dealing with
anyone with whom a relationship could bring their impartiality into question:
(b) not influence, seek to influence, or otherwise take part in a decision o f the Minister, knowing that the decision
might further their private interests;
{c) not accept any commission, discount, allowance, payment, gift or other benefit that is connected, directly or
indirectly, with the performance of their duties related to this Agreement, that causes, or would appear to
cause, a conflict o f interest; and
(d) have no financial interest in the business o f a third party that causes, or would appear to cause, a conflict of
interest in connection with the performance of their duties related to this Agreement.
3.2 The Recipient will promptly disclose to the Minister any conflict of interest or apparent conflict of interest arising under
section 3.1.
4. TERMINATION OR COMPLETION
4.1 The parties by mutual written agreem ent may terminate this Agreem ent at any time
4.2 The Minister may terminate this Agreem ent without cause on thirty (30) days written notice to the Recipient. This
Agreem ent is terminated as o f the date given in the termination notice.
4.3 Notwithstanding anything contained herein to the contrary, the Minister may request, and the Recipient will refund
forthwith, all or part of the Grant to the Minister should the Recipient fail to fulfill any term or condition of this Agreem ent
and the M inister will have absolute discretion in determining whether a term or condition is fulfilled.
5. GENERAL PROVISIONS
5.1 In the event of any inconsistency or conflict between Schedule A, the STEP Guidelines and the rest o f this Agreement,
including the body of this Agreement, the rest o f the Agreem ent will govern.
5.2 The parties may, by mutual agreem ent in writing, add to, delete or amend any term or condition o f this Agreement.
5.3 This Agreem ent will not be assigned by the Recipient without the prior written consent of the Minister.
5.4 This Agreem ent is binding upon the parties' successors and assignees.
5.5 This Agreem ent is the entire agreem ent between the Minister and the Recipient with respect to the STEP position and
the Grant and supersedes all previous agreements, negotiations and understandings. There are no agreements,
representations, warranties, terms, conditions or commitments except as expressed in this Agreement.
5.6 No w aiver of any provision of this Agreem ent is effective unless made in writing, and any such waiver has effect only in
respect of the particular provision or circumstance stated in the waiver. No representation by either of the parties with
respect to the performance of any obligation under this Agreement is capable of giving rise to an estoppel unless the
representation is made in writing.
JSTL11132 (2016/02) Page 2 of 4
Page 35
5.7 The M inister’s responsibility pursuant to this Agreem ent is limited solely to the provision o f financial assistance in
accordance with the terms and conditions set out herein.
5.8 Nothing in this Agreem ent makes, or will be construed to make the Recipient or any of its employees, directors,
officers, contractors or agents an agent of the Minister. Nothing in this Agreem ent creates, or will be construed to
create an agency, partnership, joint venture or employment relationship between the M inister and the Recipient or any
of employees, directors, officers, contractors or agents.
5.9 The Recipient will not incur any expenses or debts on behalf of, nor make any comm itm ents for the Minister.
5.10 The M inister may, in the Minister's sole and absolute discretion, delegate any duties, powers or functions relating to the
provisions of this Agreement.
5.11 The Recipient will comply with all statutes, regulations, orders, licenses and permits applicable to the Recipient in
carrying out the STEP position.
5.12 This Agreem ent is governed by and is to be construed in accordance with the laws o f the Province of Alberta. The
parties to this Agreem ent hereby irrevocably and unconditionally attorn to the exclusive jurisdiction of the court of the
Province o f Alberta.
5.13 Time is o f the essence of this Agreement.
5.14 All section headings in this Agreem ent have been included for convenience only and will not be considered in
interpreting the text of this Agreement.
5.15 In this Agreement, words in singular will be construed to include the plural, words in the plural will be construed to
include the singular, and words, regardless of the gender in which they are used, will be construed to include the
masculine, feminine, or body corporate, as the context may require,
5.16 Notwithstanding any other provisions of this Agreement, sections 2 and 3 will survive this Agreem ent and will continue
to bind the parties.
On signature by the Minister and the Recipient, the terms and conditions and any attached Schedules, together form
the Agreem ent
RECIPIENT OR AUTHORIZED SIGNING OFFICER
__ ___ ________ Print

Date (yyyy-mm-dd)
_ Name_ and_Position
________x Signature
MINISTER OR AUTHORIZED REPRESENTATIVE
_______________ _______________x_______ _ _
Date (yyyy-mm-dd) Print Name and Position Signature
Page 36
SCHEDULE A
The approved STEP Employer Application {JSTL11101) and STEP Student Hiring Application (JSTL11102) collectively form
Schedule A to this Agreement.
JSTL11132 (2016/02) Page A of 4
Page 37
Application for Renewal of
Government Interim Land Agent License
Land Agents Licensing
The personal information on this application is being collected under the authority of the Lar d Agents Licensing Act and will be used for maintaining the
records necessary for the administration and enforcement of the Land Agents Licensing Act and Regulation. The information is managed in compliance
with the Freedom of Information and Protection of Privacy Act. Business contact information provided on this form, including address, phone number,
e-mail address, license number and type of license will be publicly available. If you have an questions about the collection of this information, please
contact the Deputy Registrar of Land Agents, Land Agents Licensing. 9th Floor, 108 Street iuflding. 9942 - 108 Street, Edmonton. AB, T5K 2J5 or
telephone 780*415-4600. For toll free access, first dial 310-0000.
Note If an interim land agent is not renewed before the license expiras, a new license will have to be applied for. If a new
license is applied for after 12 months of the expiry date of the expired license, the applicant will be required to write
an examination. Renewals are not automatic and must be justi fied.
License Number Date of Expiry (yyyy-mm-dd)
Q Mr Q Mrs. [ J Miss Q Ms.

Full Name (Surname) (First Name) (Middle)
1. Home Address
Address (Street, R .R #. P.O. Box) (City/Town) (Province) (PostalCode)
Telephone Number Fax Number Cell Number E-Mail
2. Business Address
Present Employer
Address (Street, R.R#, P.O. Box) (City/Town) (Province) (Postal Code)
3. Mailing Address
Same As: [ ] Home Q Business OR Below
Address (Street. RR.#, P O 3ox) (City/Town) (Province) (PostalCode)
Continued on next page

For Office Use Only
Cheque Number Receipt Number
LALQ002 (2014/05) Page 1 of 2
Page 38
4. Please Answer the Following Questions
a) How many negotiations have you conducted to date? |_______|

b) W hat is your reason for requesting renewal? (attach additional sheet if required)
c) Have you been convicted of an offence, other than a minor traffic violation? □ Yes □ No
If yes. explain:
d) Do you have a criminal record for which a Pardon has not been granted? □ Yes □ No
If yes, explain:
5. Training Agreement
Please check and complete o ne of the following:

The Training Agreem ent between m yself (Trainee) and
name of trainer
dated ___________ - _________ is hereby renewed with any amendments thereto.
date
Date (yyyy-mm-dd) Signature of Trainer or Trainer's Authorized Representative
Date (yyyy'FTxn-dd) Signature of Trainee
Q I have entered into a new Training Agreement (attached).
6. Signature of Applicant
Date fyyyy-mm-dd) Signature of Applicant
7. Payment Information
The governm ent of Alberta has implemented a policy, which involves accepting and processing credit card payments
online through a secure payment system. This policy identifies that the acceptance of credit card payments m ust be
Payment Card Industry - Data Security Standard (PCI-DSS) compliant, which means we will not accept credit card
information by phone, email, fax or on our application forms.
If you wish to make a payment using a credit card, an e-commerce solution has been provided for your use. You can go
to the Land Agents Licensing website to make a payment.
http://work.alberta.ca/labour/la nd-aqents-licensinq.html
Once you have made the payment of $100.00 (GST exempt), you will receive an electronic receipt. The electronic receipt
m ust be printed, and sent along with your completed application form to the Land Agents Licensing Office for processing.
Paym ent with a cheque or money order will still be accepted, please make it payable to the Government of Alberta.
Please note: your application will not be processed without this fee
The completed form and electronic receipt can be sent to:
Alberta Jobs, Skills Training and Labour

Land Agents Licensing g
9th Floor, 9 9 4 2 - 108 Street
Edmonton, AB, T5K 2J5
Statutory Declaration
The personal information on this application is being collected under the authority of the Land Agents Licensing Act and will be used for maintaining
the records necessary for the administration and enforcement of the Land Agents Licensing Act and Regulation The information is managed in
compliance with the Freedom of information and Protection of Privacy Act. Business contact information provided on this form, including address,
phone number, e-mail address, license number and type of license will be publicly available. If you have any questions about the collection of this
information, please contact the Deputy Registrar of Land Agents Licensing. 9th Floor, 108 Street Building. 9942 -108 Street, Edmonton. AB, T5K 2J5
or telephone 780-415-4600. For toll free access, first dial 310-0000.
CANADA In th e M a tte r o f th e Lo ss o f In terim Land A g e n t

PROVINCE OF ALBERTA
TO WIT: }
L ic e n s e N o . ________________________
interim land agent license no.
full name
Of ________________ _________________________________________ , __________________

full address province postal code
do solemnly declare:
that I have misplaced/lost my wallet sized interim land agent license numbered _____
interim land agent license no
and therefore, require a replacement license to be issued,
I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect
as if made under oath and by virtue of The Canada Evidence Act.
DECLARED before me at t h e __________ _ _____________________
o f ___________________________________________ in the Province of

Signature of Declarant
___________ _________________________ , this ___________________ _ Print or Stomp Name and

province day Appointment Expiry Date
day o f _______________________________ _________

month year
(Signature of a Commissioner for Oaths in and for the Province of Alberta)
The government of Alberta has implemented a policy, which involves accepting and processing credit card payments online through a
secure payment system. This policy identifies that the acceptance of credit card payments must be Payment Card Industry - Data
Security Standard (PCI-DSS) compliant, which means we will not accept credit card information by phone, email, fax or on our
application forms,
If you wish to make a payment using a credit card, an e-commerce solution has been provided for your use You can go to the Land
Agents Licensing website to make a payment.
http://work-alberta.ca/labouri/land-aaents-licensina html
Once you have made the payment o f $25.00 (GST exempt), you will receive an electronic receipt, The electronic receipt must be
printed, and sent along with your completed application form to the Land Agents Licensing Office for processing.
Payment with a cheque or money order will still be accepted, please make it payable to the G overnm ent o f Alberta.
Please note: your application will not be processed without this fee.
9th Floor, 9942 - 106 Street
Approval (For Office Use Only)

Approved Date [yyyy-mm-dd) Deputy Registrar Signature
□ Yes □ No
LAL 0003 (2014/05)
Page 40
Receipt o f Proposed A greem ent
The personal information on this application is being collected under the authority of the Land Agents Licensing Act and wiB be used for maintaining the
records necessary for the administration and enforcement of the Land Agents Licensing Act and Regulation The information is managed in compliance
with the Freedom of Information and Protection of Privacy Act Business contact information provided on this form, including address, phone number,
e-mail address, license number and type of license will be publicly available. If you have any questions about the collection of this information, please
contact the Deputy Registra' of Land Agents. Land Agents Licensing. 9lh Floor 108 Street Building, 9942 - 108 Street. Edmonton. AB, T5K 2J5 or
telephone 780-415-4600. For toll free access, first dial 310-0000.
1. Land Agent
i , ____________________________________________ o f _________________________ _____ri__ ____________________

land agent complete address
_________________________________________________ __ _______ holding Land A gent License No. ___ ___________________

land agent license no.
in the Province of Alberta, am representing

name of individual or corporation acquiring an interest
and on _________________ at left
date (yyyy-mm-dd) time land owner or agent
of ________________________________________________________________________________________ a completed copy of
complete address
the attached proposed agreement for an interest in the land(s) listed in section 3 . 1 explained the provisions o f Section 17
of the Land Agents Licensing A ct and, in particular, that negotiations cannot resume or an agreement cannot be signed
until at least 48 hours have passed, unless a waiver in the prescribed form is signed. I offered to explain to the owner, or
the owner’s agent, the proposed term s of the agreement and the owner □ accepted □ declined my offer.
2. Land Owner
I, _________________________________ acknowledge that on _____________ at

land owner or agenf dale (yyyy-mm-dd) time
I received a completed copy of the attached proposed agreement for an interest in the land(s) listed below in section 3
and did not waive the application of Section 17(2) of the Land Agents Licensing Act. The land agent offered to explain the
proposed term s of the agreement to me and I □ accepted [ )declined the offer.
3. Land(s) {Legal Land Description)
Dale (yyyy-mm-dd) Date (yyyy-mm-dd)
Signature of Land Agent Witness
Date (yyyy-mm-dd) Date (yyyy-mm-dd)
Signature of Land Owner or Agent Witness
LAL 0004 (2013/11) Page 1 of 1
Page 41
Application for Renewal of
Government Permanent Land Agent License
The personal information on this application is being collected under the authority of the Land Agents Licensing Act and wil be used for maintaining the
records necessary for the administration and enforcement of the Land Agents Licensing Act and Regulation The information is managed in compliance
with the Freedom of Information and Protection of Pnvacy Act. Business contact information provided on this form, including address, phone number,
contact the Deputy Registrar of Land Agents. Land Agents Licensing. 9th Floor. 108 Street Building. 9942 -108 Street. Edmonton. AB. T5K 2J5 or
telephone 780-415-4600. For toll free access, first dial 310-0000
Note ^ If a permanent land agent is not renewed before the license expires, a new license will have to be applied for. If a new
license is applied for after 12 months of the expiry date of the expired license, the applicant will be required to write an
examination. If a new license is applied for after 36 months of the expiry date of the expired license, the applicant may
be required to fulfill additional requirements.
License Number Date of Expiry iyyyy-mm-ddl Date Of Birth iyyyy-mm-ddl
1
Q Mr. [ J Mrs. Q Miss Q ] Ms
Full Name (Surname; fF/rsf Name) (Middle)
1. Home Address
Address |Street R R # P O Bo*) lOty/Townl <ProvinceI (Postal Code)
2. Business Address
Present Employer
Address (Street RR.U P O Bo*) (Qty/Towm iProvince) (PostalCode)
Telephone Number Fax Number Cell Number | E -M a il
3. Mailing Address
Same As: Q Home Q j Business OR Q Below
Address (Sf/eef. RR#. P O Sox; (City' Town) (Province) (PostalCode)
| Telephone Number ] Fax Number Cell Number E-Mail

i
i

For Office Use Only
LAL0005 (2014/05) Page 1 of 2
Page 42
4. Please Answer the Following Questions
Since the date of your last renewal or the date your license was issued if this is your first renewal:
a) Have you been convicted of an offence, other than a minor traffic violation. 0 Yes □ No
If yes, explain
b) Do you have a criminal record for which a Pardon has not been granted? 0 Yes □ No
If yes. explain-
c) Have you been refused registration or licensing, or had such registration or licensing been 0 Yes 0 No
suspended, cancelled or revoked in Alberta or elsewhere, under any legislation which
requires registration or licensing to deal with the public in any capacity?
Explain.
d) Have you performed land agent work or supervised any licensed land agents? 0 Yes 0 No
Explain
5. Renewal Qualifications
Your application will not be considered unless a Permanent Land Agent License Renewal Qualification Form (Schedule
1.2 of the Land Agents Licensing Regulation) is attached
Date ( y y y y m m - d d ) Signature of Applicant
The governm ent of Alberta has implemented a policy, which involves accepting and processing credit card payments
online through a secure payment system. This policy identifies that the acceptance o f credit card payments must be
http://work.alberta .ca/labour/land-aoents-licensina.html
must be printed, and sent along with your completed application form to the Land Agents Licensing Office for processing.
Payment with a cheque or money order will still be accepted- please make it payable to the Government of Alberta,
Alberta Jobs. Skills Training and Labour

Land Agents Licensing Page 43
9th Floor. 9942 -1 0 8 Street
Edmonton. AB, T 5 K 2J5
Statutory Declaration
T he personal information on this application is being collected under the authority of the Land A gents Licensing Act and will be used for maintaining the
records necessary for the administration and enforcem ent of the Land Agents Licensing Act and Regulation. The information is m anaged in compliance
with the Freedom of information and Protection of Privacy Act. Business contact information provided on this form, including address, phone number, e -
mail address, license num ber and type of license will be publicly available. If you have any questions about the collection of this information, please
contact the D eputy Registrar of Land Agents Licensing. 9th Floor, 108 Street Building. 9942 - 10S Street, Edm onton, A B . T5K 2J5 or telephone
78 0*4 1 5 -4 6 0 0 . For toll free access, first dial 31 0-0 000 .
Ca n a d a \ In the M atter o f the Loss o f Perm anent Land Agent

p r o v in c e OF a l b e r t a \ License No.
TO W IT. I perm anent land agent license no.
Full name
of
full address Province Postal Code
do solemnly declare:
that I have misplaced/lost my wallet sized permanent land agent license numbered
perm anent lard agent license no.
and therefore, require a replacement license to be issued.
I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect
as if made under oath and by virtue of The Canada E vidence Act.
DECLARED before me at the
of in the Province of
Signature of D eclarant
this
Province day Print or Stamp Name and
Appointment Expiry Date
day o f ____________________________ _____
month year
(Signature of a Com m issioner for Oaths in and for the Province of Alberta)
The government of Alberta has implemented a policy, which involves accepting and processing credit card payments online through a
secure payment system. This policy identifies that the acceptance of credit card payments must be Payment Card Industry - Data
Security Standard (PCI-DSS) compliant, which means we will not accept credit card information by phone, email, fax or on our
application forms.
If you wish to make a payment using a credit card, an e-commerce solution has been provided far your use. You can go to the Land
Agents Licensing website to make a payment.
htto://work.alberta ca/labour/land-aaents-licensino htmj
Once you have made the payment of $25.00 (GST exempt), you will receive an electronic receipt. The electronic receipt must be
printed, and sent along with your completed application form to the Land Agents Licensing Office for processing.
Payment with a cheque or money order will still be accepted please make it payable to the G overnm ent o f Alberta.
The com pleted form and electronic receipt can be sent to:
9th Floor, 9942-1 08 Street
A pproved D ate tyyyy-mm-dd) Deputy Registrar Signature
□ Yes □ No
LA L0006 (2 0 1 4 /0 5 )
Page 44
jQdlm 'b&j* Government Change o f Address
The personal information on this application is being collected under the authority of the Land A gents Licensing Act and will be used for maintaining the
records necessary for the administration and enforcem ent of the Land Agents Licensing Act an d rtegutafron. The information is managed in compliance
e-m ail address, license number and type of license will be publicly available. If you have any questions about the collection of this information, please
contact the Deputy Registrar of Land Agents, Land Agents Licensing. 9th Floor, 108 Street Building. 99 42 - 1 0 8 S tre e t Edmonton, A B . T5K 2J5 or
telephone 78 0 -4 1 5 -4 6 0 0 . For toll free access, first dial 310-0000.
License N um ber Expiry D ate (yyyy-mm-dd)
] Mr. Q ] Mrs. Q Miss Ms.

Full N am e (Surname) (First Name) (Middle) D a te o f Birth (yyyy-mm-dd)
1. Home Address
Address (S tre e t R.R.#. P.O. Box) (City /Town) (Province) (Postal Code)
Phone Fax Cell E-M ail
2. Employer's Address
Present Employer
Address (Street, R R U . P O . Box) (City/Town) (Province) {Postal Code)
3. Mailing Address
Same As: D Home Address 0 E m p lo y e r OR C Below
Address (S tre e t RR. t t. P O. Box) (City / Town) (Province) (Postal Code)
4. Signature
Date (yyyy-mm-dd) Signature of License Holder
LAL 0008 (2013/11) Page 1 of 1
Page 45
Government Perform ance Evaluation
The personal information on this application is being collected under the authority of the Land Agents Licensing Act and Regulations.
The information is managed in compliance with the Freedom o f Information and Protection o f Privacy Act. Business contact information
provided on this form, including address, phone number, e-mail address, license number and type of license wrH be publicly available.
If you have any questions about the collection of this information, please contact the Deputy Registrar of Land Agents, Land Agents
Licensing. 9th Floor, 108 Street Building, 9942 -1 0 8 Street. Edmonton. AB, T5K 2J5 or telephone 780-415-4600 For toll-free access,
first dial 310-0000.
A. Certification
U nder the Training A g reem ent d a t e d __________________ , ________________________________certifies that:

Date (yyyy-mm-dd) Name of Trainer
( 1 ) __________________________________________ , holding Interim Land Agent License N u m b e r______________________

Nam e of Trainee Interim License No.
has completed the following requirements set by the Registrar of Land Agents:
[ ] Successfully passed the Distance Learning Course based on Reference Manual for Alberta Land Agents.
□ Conducted of the minimum 10 required negotiations, as listed in Attachment A, for interests in
(numberj land in Alberta that were observed by one or more of the permanent land agents
named in this evaluation.
□ Conducted of the minimum 15 required negotiations, as listed in Attachment B, for interests in
(num ber)” ,and in Alberta that were reviewed by one or more of the permanent land agents
named in this evaluation.
(2) The following permanent land agents supervised

Nam e of Trainee
(a) ___________________________________________ _________________

N am e License No,
(b) ___________________________________________ _________________

Nam e License No.
<C) ___________________________________________________________ _______________________

Nam e License No.
(«0 _________________________________________ ________________

N am e License No.
(3) The permanent land agents named in subsection (2) held a valid permanent land agent license and were
actively involved in land agent work for at least 3 years immediately preceding the date of
____________________________________ 's interim land agent license application.
Nam e of Trainee
LAL0C09 (2013/11) Page 1 of 5
Page 46
(4) The following comments on ____________________________________ 's performance were reviewed and
N am e of Trainee
agreed to by the permanent land agents named in subsection (2):
(a) Describe the articling land agent’s performance in such matters as attention to detail in negotiations and
documentation, congeniality with land owners, adherence to time limits and standards of conduct
prescribed in the Regulation, skill development in relation to the employer's expectations and general
integrity in performance of land agent work.
(b) Identify any areas for recommended improvement or change and additional training:
(c) Describe what you have done to encourage development in those areas described in clause (b):
£age47-
B. Recommendation
________________________________ recom m ends th at th e R egistrar o f Land Agents

Name of Trainer
□ Accept
□ Not Accept (give reasons):
________________________________________ __ ‘s application for a permanent land agent license under the Land A gents
N am e of Trainee
Licensing Regulation (Alberta).
D ate (yyyy-mm-dd)
Printed N am e Signature of Trainer's Authorized Represented as indicated

on the Training Agreem ent
LAL0009 (2013/11) Page 3 of 5
Page 48
Attachment A
LIST OF OBSERVED NEGOTIATIONS
Legal Description Type of Negotiation D ate of Agreem ent N am e of Person(s) pk n h

(as shown on title) (e,g. Easem ent. Surface Lease, etc.) (yyyy-mm-dd) negotiated with
10
Page 49
Attachment B
LIST OF REVIEWED NEGOTIATIONS
Legal Description Type of Negotiation D ate ot Agreem ent N am e of Person(s)

Phone Numbers
(as shown on title) (e.g. Easem ent. Surface Lease, etc.} (yyyy-mm-dd) negotiated with
10
11
12
13
14
15
LAL0009 (2013/11) Page 5 of 5
Page 50
G o vern m en t Application fo r Perm anent Land A gent License
The personal information on this application is being collected under the authority of the Land Agents Licensing Act and will be used for maintaining the
with the Freedom of Information and Protection of Privacy Act Business contact information provided on this form, including address, phone number,
contact the Deputy Registrar of Land Agents, Land Agents Licensing, 9th Floor, 108 Street Building, 9942 • 108 Street, Edmonton, AB. T5K 2J5 or
telephone 780-415-4600. For toll free access, first dial 310-0000,
Interim License Number Date of Expiry (yyyy-mm-dd) Expired Permanent Land Agent License No. Date of Expiry (yyyy-mm-dd)
Q Mr. Mrs. Q Miss Q Ms.

Full Name (Surname) (First Name) (Middle) Date of Birth (yyyy-mm-dd)
-
1. Home Address
Address (Street. R.R.#, P.0 Box) (City/Town) (Province) (Postal Code)
2. Business Address
Present Employer
Address (Street. RR.it. P.0 Box) (City f Town) (Province) (Postal Code)
3. Mailing Address
Same As: □ Home □ Business OR Q Below
Address (Street. R.R.tt. P O Box) (City/Town) (Province) (Postal Code)
For Office Use Only

LAL0010 (2014/05) Page 1 of 2
Page 51
4. Application Requirements
Your application will not be considered until the Registrar has received the following;
a) Completed Performance Evaluations from all your Trainers that you have entered into Training Agreements with.
b) Proof that you have successfully completed the Land Agent Education Program as required by the Registrar.
5. Please Answer the following questions
1) Have you been convicted of an offence, other than a minor traffic violation? □ Yes □ No
If yes. explain.
2) Do you have a criminal record for which a Pardon has not been granted? □ Yes □ No
If yes. explain
Date yyyy-mm-dd Signature
The government of Alberta has implemented a policy, which involves accepting and processing credit card payments
online through a secure payment system. This policy identifies that the acceptance of credit card payments must be
http://work.alberta.ca/labour/land-aaents-licensing.html
Payment with a cheque or money order will still be accepted, please make it payable to the Government of Alberta.

9th Floor. 9942 - 108 Street
Approval (For Office Use Only

Approved Date {yyyy-mm-dd) Deputy Registrar Signature
□ Yes □ No
Page 52
G o vern m en t Application fo r Interim Land A gent License
Land A gents Licensing
The personal information on this application is being collected under the authority of the Land Agents Licensing Act and will be used for maintaining the
contact the Deputy Registrar of Land Agents, Land Agents Licensing. 9th Floor, 108 Street Building. 9942 -108 Street, Edmonton. AB. T5K 2J5 or
telephone 780-415-4600 For loll free access, first dial 310-0000
□ Mr. □ Mrs. □ Miss □ Ms.

Full Name (Surname) (First Name) (Middle) Date of Birth (yyyy-mm-dd)
-
1. Home Address
Address (Street, R R #. P O Box) (City/Town) (PrownceJ (Postal Code)
Telephone Phone Fax Number Cell Number E-Mail
2. Business Address
Present Employer
Address (Street, PR.#, AO. Box) (City/ Town) (Province) (Postal Code)
3. Mailing Address
Same As: □ Home □ Business OR □ Below
Address (Street. R R U. P. 0 Box) (City /Town) [Province) (Postal Code)
For Office Use Only

LAL0011 (2014/05) Page 1 of 3
Page 53
4. Your Employment History for Previous Five Years
Employer's Name Supervisor Phone Dales (from and to) Position Held
5. If you answer Yes to any of the following questions, give complete details in the space provided in Section 6.
1. If you were issued an interim land agent license, would you carry on any business p Yes p No
other than land agent activity?
2. During the period of your training, do you plan to attend any training program(s) or p Yes p No
course(s)?
3. Have you previous experience in Alberta or elsewhere as a "land agent" as that term is p Yes p No
defined in the L a n d A gents Licensing A ct ?
4. Have you ever been registered or licensed in Alberta or elsewhere under any legislation p Yes p No
which required registration or licensing to deal with the public in any capacity?
5. Have you ever been refused registration or licensing, or had such registration or licensing p Yes p No
suspended, cancelled or revoked in Alberta or elsewhere, under any legislation which
requires registration or licensing to deal with the public in any capacity?
6 Have you ever changed your name? Q] Yes □ No
7. Have you ever been convicted of an offence other than a minor traffic violation? □ Yes □ No
8 Do you have a criminal record for which a Pardon has not been granted? □ Yes □ No
6. If you answered Yes to any of the questions in the previous section, give complete details below.
7. If you have held an Interim Land Agent License before, please complete the following:
Page 54
Previous License Number Reason(s) why you did not obtain a permanent Land Agent License
Indicate the number o f negotiations you conducted to date under any previous training agreements:
Number of Negotiations Date of Agreement Trainer Termination Date
8. Your application will not be considered unless the following are attached
a. Proof that you have satisfactorily completed at least 2 years of post-secondary education that is relevant to the
activities of a land agent
b. An executed Training Agreement as outlined in the Land A gents Licensing R egulation
Date (yyyy^mm^kj) Signature of Applicant
The government of Alberta has implemented a policy, which involves accepting and processing credit card payments
online through a secure payment system. This policy identifies that the acceptance of credit card payments must be
http:/ywork.alberta.ca/labour/land-agents-licensina.html
Payment with a cheque or money order will still be accepted, please make it payable to the Government of Alberta.

9th Floor, 9942 - 108 Street
Edmonton, AB, T5K2J5

Approved Date (yyyy-mm-dd) Deputy Registrar Signature
□ Yes □ No
LAL0011 {2014/05} Page 3 of 3
Page 55
Government
of Alberta ■ Statutory Declaration
CANADA
PROVINCE OF ALBERTA
TO WIT In th e M a tte r o f
i , ______________ Of
(full address)
in the Province of , do solemnly declare:

(province) (posiai code)
And i make this solemn declaration conscientiously believing it to be true, and knowing that is of the same force and
effect as if made under oath and by virtue of The Canada Evidence Act.
__________________ L
J
LAL3168 [Fin 26A) (2011/04)
Page 56
SCHEDULE 2
(Section 8(1))
WAIVER OF APPLICATION OF SECTION 17(2) OF THE ACT
name of owner or owner's agent
of acknowledge
address
have entered into negotiations with respect to an agreement for an interest in the following lands:
land description
in favour o f __________
name of person or entity
and make oath and say:
1. T h a t __________________________ _____________________________ holding _____________________________________

name of land agent permanent or interim land agent license no.
has explained to me the provisions of Section 17 of the Land Agents Licensing Act.
2. That I fully understand that I can wait at least 48 hours from the time that a completed copy of the proposed agreement
is left with me for examination before I can be requested to resume negotiations or to sign the agreement.
3. That I waive the application of Section 17(2) of the Land Agents Licensing Act.
Signature of Owner or Owner's Agent
Print or Stain p Name and

(Signature of a Commissioner for Oaths in and for the Province of Alberta}
LAL 3254 (2011/04) Page 1 o f 1
Page 57
SCHEDULE 3
(Section 8(2))
STATEMENT OF LAND AGENT ACTING AS COMMISSIONER FOR OATHS
, land agent, of
name in full
acknowledge
address
having entered into negotiations with respect to an agreement for an interest in the following lands'
land description
in favour o f __________
name of person or entity acquiring an interest
and make oath and say:
That I explained t o _______________________________ ____________ _______________________________ the provisions of

name of owner or owner's agent
Section 17 of the Land Agents Licensing A ct and, in particular, that he/she could w ait at least 48 hours from the time that
a completed copy of the proposed agreement was left with him/her before he/she could be requested to resume
negotiations or to sign the agreement.
Signature of Owner or Owner's Agent
Print or Stamp Name and


J
L A I 3255 (2011/04) Page 1 of 1
Page 58

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In fo rm atio n an d P rivacy O ffice

L abour 4th Floor Labour Building

Dear Mr. Johnson:

RE: Freedom of Information and Protection of Privacy Act

Enclosed are 58 pages of responsive records.

Personal Inform ation

Mailing Address City Province/Terntory Postal Code

Expense C ategory A m ount

Private V ehicle Rate: $0.505/Km No. of Km $0.00

A ccom m odation (Attach receipts)

Per D iem Q ln Country $7.35

Date (yyyy-mm-dd) Member's Name Signature of Member

Date iyyyy-mm-M) Expenditure Officer's Name Signature of Expenditure Officer

ADMINJSTL0004 (2015/05) Page 1 of 1

Canada-Alberta Job Grant

Part A - Employer Information

Operating Name. Mailing Address:

City: Province: Postal Code

Country: Phone Number Fax Number:

Business Address: (if different from mailing address above) City:

Province: Postal Code. Country: Number of Employees:

Phone Number: Alternate Phone Number: Email Address:

CJGQ001 (2015/08) Page 1 of 5

Course Title: Delivery Method:

Credential/Certificate Awarded on Completion:

□ in d u s try or occupation credential or certificate

□ S pecialized or technical skills

□ M anagem ent and business skills

□ in tro d u ce new technology, machinery/equipment and/or new processes

□ F o s te r innovation in the business/workforce

□ D e ve lo p leadership potential of Trainee

Provider Name: Provider Contact Person Contact Person Phone Number:

City: Province: Postal Code:

Canada-Alberta Job Grant Terms and Conditions:

2. UNDERTAKINGS AND CONDITIONS RELATED TO THE GRANT:

CJG0001 (2015/08) Page 3 of 5

Declaration and Authorization of Employer's Authorized Signing Official

Date (yyyy-mm-dd) Print Name Title Signature

Office Use Only

Date (yyyy-mm-dd) Print Name Title Signature

CJG0001 (2015/08) Page 5 of 5

Canada-Alberta Job Grant

Part A - Employer Information

Part B - Trainee Information

Part C - Receipts For Training Costs

CJG0002 (2015/08) Page 1 of 3

Declaration and Authorization of Employer's Authorized Signing Official

Date (yyyy-mm-dd} Print Name Title Signature

Office Use Only

Date (yyyy-mm-ddi Amount Approved Signature

Province Postal Code feiephone Number (include area code)

OPT IN - Vendor email address for electronic remittance advice

*107. 12271. MESted

CJG0002 (2015/08) Page 3 of 3

Canada-Alberta Job Grant

Part A - Employer Information

Pavt B • Employer Satisfaction

The Canada-Alberta Job Grant processes were easy to follow □ ' Q 2 Q 3 0 * □ 5

Part C - Training Outcome____________ _______ _______ ________________________________

Add TraineefTraining Course Remove Trainee/Training Course

CJG0003 (2015/08) Page 1 o f2

Add Course Remove Course

Declaration and Authorization of Employer's Authorized Signing Official

Part C - Training Outcome________ _ _ ____________________________