Jobs for Life - Christian Help

GENERAL INFORMATION

Name*

First Last

Gender*

Birthday*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Please list any medical restrictions or other special needs.

WORK STATUS

Are you a United States Citizen?*

Yes

If no, can you provide proof of residency?

Yes

Are you legally authorized to work in the US?*

Yes

If no, 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

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

If yes, please describe below.

Please include the Incident, Year, City, State and Charge & Release Date.

Are you willing to take a drug test?*

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

Yes

CURRENT EMPLOYMENT STATUS

Check all that apply*

Unemployed

Part-time job

Full-time job

Self Employed

Retired

Other

Name of employer

Industry

Current hourly wage (optional)

JOBS FOR LIFE TRAINING INFORMATION

What is your reason for taking Jobs for Life training?*

What is your present career goal or objective?*

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?

Date Form Submitted*

Jobs for Life Applicant Background Information

GENERAL INFORMATION

WORK STATUS

EDUCATIONAL BACKGROUND INFORMATION

SECURITY

CURRENT EMPLOYMENT STATUS

JOBS FOR LIFE TRAINING INFORMATION

PREVIOUS WORK EXPERIENCE