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Wired 2 Hire Registration Form
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* Required
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Preferred Name
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Mailing Address
*
Your answer
Postal Code
*
Your answer
Cell Phone Number
*
Your answer
Home Phone Number
Your answer
Preferred Method of Contact
*
Cell Phone Number
Home Phone Number
Email
Status in Canada
*
Canadian Citizen
Permanent Resident
Student Visa
Country of Citizenship
Your answer
Employment Status
*
Full Time
Part Time
Unemployed
In School
How did you hear about this program?
*
Your answer
Date Submitted
*
MM
/
DD
/
YYYY
By submitting a valid email address and checking the box below you agree all information submitted is accurate and valid to the best of your knowledge and you wish to be contacted about the Wired 2 Hire program
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