Work Entry

Jobs for Life is an 8-week experience.

Interested in participating in Jobs For Life? You’ll be glad you did. Our encouraging and dedicated team will help you identify a career path and open doors of opportunity to help you rise to the next level.

Complete this application and someone from the Jobs For Life Team will contact you soon to schedule your interview.

Please note: your responses to the following questions WILL NOT disqualify you from participating in Jobs for Life. JFL leaders will keep personal information disclosed on this form confidential.

General Information

First Name

Last Name

Your Email Address

Biological Sex

Address

Phone

Date of Birth

Ethnicity

Work Status

Are you a United State Citizen?

If no, can you provide proof of residency?

Are you currently legally authorized to work?

If no, are you in the process of securing work authorization

Will you be able to provide the following forms?

US Social Security Card

US Green Card

Driver's License

Please list any physical handicaps or other special needs

Educational Background Information

Highest Grade Completed

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

If yes, what training/degree did you receive?

Security

Do you have a criminal history

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

If yes, please describe below. Note: Providing this information will not disqualify a person from becoming a Jobs for Life student.

Incident

Incident Year

City & State

Charge & Release Date

Are you willing to take a drug test?

Current Employment Status

Employment Status

Unemployed Part-time job Full-time job Self-employed Retired

If employed, name of employer

Industry

Current hourly wage

Are you a current recipient of government assistance?

Martital Status

Number of children

Housing Arrangements

If other, please explain

Jobs for Life Training Information

Are there any barriers or concerns that would keep you from attending every session?

If yes, describe them here and we’ll do our best to help.

What is your reason for taking Jobs for Life training?

What is your present job goal or objective?

Previous Work Experience

List you last four employers, start with your most recent or current employer. Please include military and volunteer experience. Be as complete as possible

Employer #1

Business Name

Address

Phone

Start Date

End Date

What is/was your job title?

What are/were your duties?

Who is/was your supervisor?

Reason for leaving:

Employer #2

Business Name

Address

Phone

Start Date

End Date

What was your job title?

What were your duties?

Who was your supervisor?

Reason for leaving:

Employer #3

Business Name

Address

Phone

Start Date

End Date

What was your job title?

What were your duties?

Who was your supervisor?

Reason for leaving:

Employer #4

Business Name

Address

Phone

Start Date

End Date

What was your job title?

What were your duties?

Who was your supervisor?

Reason for leaving:

How did you learn about Jobs for Life?

Submit

JFL Application

Work Entry

General Information

Work Status

Educational Background Information

Security

Current Employment Status

Jobs for Life Training Information

Previous Work Experience

Employer #1

Employer #2

Employer #3

Employer #4

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