JfL Class - Student Application General Informaton First Name Last Name GenderPlease select... Female Male Street Address City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Zip Code Phone Email Date of Birth EthnicityPlease select... Caucasian African American Hispanic Asian Other How did you first hear about this Jobs for Life class? Were you referred to this class through another ministry or organization? If so, which one? Work Status Are you a U.S. Citizen?Please select... Yes No If no, can you provide proof of residency?Please select... N/A Yes No Are you currently legally authorized to work?Please select... Yes No If no, are you in the process of security work authorization?Please select... N/A Yes No Have you ever served in the military?Please select... Yes No Check the following forms of ID you haveU Social Security CardValid Driver LicenseUS Green CardPassportNone of the Above Please List any physical handicaps or other special needs Educational Background Information What is the highest level of education completed?Please select... 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade/GED Vocational Training Community College College Graduate School Have you ever received a certificate or degree from a college or training facilityPlease select... Yes No If yes, what training/degree did you receive? Background Information Do you have a criminal record? (Please note, providing this information will NOT disqualify you from attending a Jobs for Life class.)Please select... Yes No Have you ever been convicted of a felony and/or served time in the past? (Please note, providing this information will NOT disqualify you from attending a Jobs for Life class.)Please select... Yes No Are you a current recipient of government assistance?Please select... Yes No Housing arrangementsPlease select... Rent Own Homeless Other If 'other' please explain Current marital/family/housing statusPlease select... Married Single Divorced Separated Windowed Do you have any children under the age of 18? If so, how many? Current Employment Status Check all that applyUnemployedEmployed (full-time)Employed (part-time)Self EmployedRetired If currently employed, list name of employer and position Additional Information What do you want to participate in this Jobs for Life class? What are your hopes and expectations? What are your job goals and/or career goals? Please list any hobbies that you have (ex: reading, cooking, sports, etc) To graduate from this class, you must miss no more than 3 class session. Are there any reasons you may not be able to attend any of the scheduled classes? Please check with your class administrator if you are not sure of the class schedule. Please list any additional information that would help us know you better. You may also use this space to provide additional comments or questions you may have. reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. Contact Information
