Application

750 Marcel-Laurin #450, Saint-Laurent (Québec) H4M 2M4
Phone: (514) 744-2944, ATS/TTY: (514) 744-2613
Fax: (514) 744-5711
Email : emploi@aimcroitqc.org

Please complete this form. We will then contact you by phone or TDD (telecommunication device for the deaf) to set up a meeting with one of our counsellors.

Note: Only the information marked with an asterisk (*) is compulsory, but please feel free to fill out the remaining fields if you so desire.

Date :
* Last name :
* First name :
Address :
City :
Postal code :
* Telephone :
Other telephone :
Handicap(s) / limitation(s) :
Who referred you?
Employment sought :
Sex :	Female Male
Email :