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1. Employment and Wellness Program
2. Confirmation
Employment and Wellness Program
The Employment and Wellness Program is a 16 week addiction and mental health support program that provides counselling, skills development and job placement opportunities to help participants obtain and maintain a job.The program is offered twice yearly in the spring and the fall. The program includes:
• 16 weeks of group and individual addictions counselling
• 16 weeks of group and individual employment counselling
If you are a referring agency, service provider or health care provider, please check the box below before providing the participant’s information.
I am the Referring Worker listed on this form and confirm that I have spoken with the participant about the purpose of Halton Region’s Employment and Wellness Program. I acknowledge that the participant has consented to the disclosure of his/her information through this on-line form. I also acknowledge that this from will not be kept if, upon contact, the participant states consent was not obtained.
Referring information:
Referring Worker Name (if applicable)
Referring Worker Organization (if applicable)
Participant information:
First Name
(required)
Last Name
(required)
Phone Number
(required)
Email
(required)
Preferred method of contact
All of the following criteria must be met by the participant prior to referral (please select all that apply):
Has had recent employment (within the past 6-12 months) with possible retention issues
Has self-identified a substance use/addiction issue
Is comfortable in group setting
If you have not checked all criteria above please explain.
**Due to the insecurity of e-mail, communication through e-mail may pose privacy/security risks. Risks include receipt by unintended recipients, viewing by others having access to the e-mail account, etc. In providing an e-mail address the participant acknowledges and accepts these risks. Halton Region will only use an e-mail address to communicate the participant’s acceptance into the program and to coordinate an assessment and appointments.
Personal information and personal health information will be used to verify eligibility for and administer Halton Region’s Employment and Wellness Program. Personal information and personal health information may also be used for statistical gathering and future program planning. The authority for collecting personal information is section 11 of the Municipal Act, 2001, S.O. 2001, c. 25. For questions, dial 311 and ask to speak with a Supervisor of Employment Services.
Confirmation