Jobs for Life - Christian Help

GENERAL INFORMATION

Name*

First Last

Preferred Name

Gender*

Male

Female

Other

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Birthday*

MM slash DD slash YYYY

Please list any medical restrictions or other special needs.*

Please list any food allergies or other special requests.*

WORK ELIGIBILITY

Are you a United States Citizen?*

Yes

Can you provide proof of residency?

Yes

Are you legally authorized to work in the US?*

Yes

Are you in the process of securing work authorization?

Yes

Do you have a US Social Security Card*

Yes

Do you have a current US Permanent Resident (Green) Card?*

Yes

Not Applicable

Do you have a current US work permit (Employment Authorization Document or EAD)?*

Yes

Not Applicable

Do you have a valid Driver’s License?*

Yes

EDUCATIONAL BACKGROUND INFORMATION

Highest grade completed*

Did you receive a certificate or diploma from a college or training facility?*

Yes

If yes, what training/degree did you receive?

SECURITY

Are you willing to take a drug test?*

Answering “No” will not disqualify a person from becoming a Jobs for Life student.

Yes

Do you have a criminal history?*

Yes

Have you ever been convicted of a felony and/or served time in the past?*

Note: Providing this information will not disqualify a person from becoming a Jobs for Life student.

Yes

Please describe below including the incident, year, city, state, charge & release date.*

What is your reason for enrolling in the Jobs for Life training?*

What is your present career goal or objective?*

CURRENT EMPLOYMENT STATUS

Check all that apply*

Unemployed

Part-time job

Full-time job

Self Employed

Retired

Other

Please explain your current employment status.

PREVIOUS WORK EXPERIENCE

List your last three employers, starting with your most recent or current employer. Include military and volunteer experience. Be as thorough as possible.

Business Name*

Business Address

Business Phone*

Start Date*

End Date*

What is/was your job title?*

What are/were your duties?*

Who is/was your supervisor?*

If you are no longer employed here, why did you leave?*

Business Name

Business Address

Business Phone

Start Date

End Date

What is/was your job title?

What are/were your duties?

Who is/was your supervisor?

If you are no longer employed here, why did you leave?

Business Name

Business Address

Business Phone

Start Date

End Date

What is/was your job title?

What are/were your duties?

Who is/was your supervisor?

If you are no longer employed here, why did you leave?

Jobs for Life Applicant Background Information

GENERAL INFORMATION

WORK ELIGIBILITY

EDUCATIONAL BACKGROUND INFORMATION

SECURITY

CURRENT EMPLOYMENT STATUS

PREVIOUS WORK EXPERIENCE