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Jobs for Life Application

Jobs for Life is an international, faith-based job readiness program that helps equip you with the tools to transform your life through professional development. The program focuses on the origin, value, purpose of work, Bible-based soft skills and each person’s unique gifts. The course teaches how to overcome roadblocks in your personal and professional life and helps you discover your unique value potential.

All personal information disclosed on this form will be kept confidential. Photographs or videos will be taken during these classes.

"*" indicates required fields

Personal Information

Name*

First Last Preferred First Name

Gender*

Male

Female

Other

Address*

Street Address Address Line 2 City State ZIP Code

Email Address*

Enter Email Confirm Email

Phone Number*

Birthday*

MM slash DD slash YYYY

Please list any medical restrictions or special needs.*

Please list any food allergies or other special requests.*

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

How did you hear about Jobs for Life?*

What parts of your life do you feel you can improve most?*

What are your strengths?*

What are your weaknesses?*

What is your "dream job?"*

Realistically, what do you want to be when you "grow up?"*

Education

Highest Education Level*

Have you received a certificate or diploma from a college or training facility?*

Yes

What training or degree did you receive?*

When & where was this received?*

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

Not Applicable

Do you have a US Social Security Card*

Yes

Do you have a valid Driver’s License?*

Yes

Do you have a current US Permanent Resident Card?*

Yes

Not Applicable

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

Yes

Not Applicable

Background

Are you willing to take a drug test?*

Yes

Do you have a criminal history?*

Yes

Have you been convicted of a felony and/or served time?*

Yes

In detail, please describe below including the incident, year, city, state, charge & release date.*

Employment

What is your current employment status?*

Full-time job

Part-time job

Self Employed

Unemployed

Retired

Other

Please explain.*

Work Experience

List your last three employers, starting with your most recent or current employer. Be as thorough as possible.

No Job

I have never had a job before.

Job #1 or Current Job

Business Name*

Who is/was your supervisor?*

First Name Last Name

Address*

Street Address Address Line 2 City State ZIP Code

Start Date*

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Business Phone*

What is/was your job title?*

What are/were your duties?*

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

Job #2

Business Name*

Who is/was your supervisor?*

First Name Last Name

Address*

Street Address Address Line 2 City State ZIP Code

Start Date*

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Business Phone*

What is/was your job title?*

What are/were your duties?*

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

Job #3

Business Name*

Who is/was your supervisor?*

First Name Last Name

Address*

Street Address Address Line 2 City State ZIP Code

Start Date*

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Business Phone*

What is/was your job title?*

What are/were your duties?*

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

About
Programs
Volunteer
Donors
Events
News
50th Anniversary Fundraiser
Applications
Contact

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