ApprenticeshipWorks Application
RequiredRequired Question(s)
This application is a confidential document and will be used only to evaluate your eligibility for the ApprenticeshipWorks Program. All information will be kept strictly confidential and will only be shared with The WorkPlace staff. You must answer ALL questions that are applicable and marked with an *.  You may be required to provide documentation for any of the information entered on this application. 
 
PERSONAL INFORMATION
 
Required 1.
REQUIRED.  Please enter the information indicated below so that we may contact you.

First Name:
Middle Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:
Cell Phone:

Required 2.
Preferred method of contact (Select 2)?
Email address
Home phone
Cell Phone
3.

Please list an emergency contact and their contact phone number

 

50 characters left.
Required 4.

Your Date of Birth:  Month/Day/Year as MM/DD/YYYY

Example: January 15, 1990 is 01/15/1990

 

50 characters left.
Required 5.

 Your Age 

 

50 characters left.
Required 6.

Gender

Male
Female
Prefer not to answer
Other  
Required 7.
Race/Ethnicity (check only one)
Black / African-American
Hispanic
Caucasian / White
Asian
Hawaiian / Pacific Islander
Native American
Other  
EDUCATION INFORMATION
 
Required 8.
What is the highest grade in school that you have completed?
In high school
Did not complete high school
High School Diploma
GED or Equivalent
Associates Degree
Bachelors Degree
9.
What is the name of your high school? 
 

50 characters left.
Required 10.

What is the date of your high school graduation?  (Type NA if you did not graduate.)

 

50 characters left.
Required 11.

What is your primary language?

English
Spanish
Other  
EMPLOYMENT INFORMATION
 
Required 12.
Are you currently employed?
Yes
No
13.

If you are currently employed, what is your employment category? (check all that apply)

Full time
Part time
Temporary position
Required 14.

If you are not currently employed, do you receive unemployment? 

Yes
No
Was receiving but it ended (Please please enter date it ended in comments)
  • Comment:

  • 500 characters left.
15.
What is the length of your total work experience?  All jobs combined.
No work experience
6 months or less
More than 6 months, up to 1 year
More than 1 year, up to 3 years
OTHER INFORMATION
 
Required 16.
What trainings are you interested in?
Manufacturing
Healthcare
Required 17.
Do you have any of the following barriers to employment?  (check all that apply)
Please understand we are here to support you and ask this question to assist us in making a proper referral or plan. 
Basic skills deficient-8th grade level or below for reading, writing, and/or math
High school drop-out
Homeless or runaway
Pregnant or parenting a child
Criminal record (past or present)
Disability
Low Income (receives cash and/or snap assistance)
Emancipated Youth
English language learner
Drug/Alcohol problems
In Foster Care
In out-of-home placement
Other  
  • Comment:

  • 500 characters left.
18.

How many people are in your household (including yourself)?

1
2
3
4 or more
I am homeless
I live in foster care
I live alone
None of the above
Required 19.

Do you or anyone in your household receive food stamps?

Yes
No
Required 20.
How are you being financially supported?
I financially support myself through employment
I am financially supported by my family
I am on my families public assistance award
I receive my own public assistance award
I receive financial assistance through another state program
I am not certain how I am financially supported
Other  
Required 21.

Are you a U.S. citizen?

Yes
No. If not, please provide Alien Registration Number in the Comment area below.
  • Comment:

  • 500 characters left.
Required 22.

If you are 18 or over, are your registered for the armed services?

Yes
No
23.

Do you have a valid driver's license?

Yes
No
Required 24.

What form of transportation do you use?

I have my own car
I have access to a friend or families car
Public Transportation
Disability transportation services
I do not have reliable access to transportation
Other  
25.

Some or all of our classes may be held virtually, do you have a device at home you can use for the virtual training? 

Yes
No
26.

Do you have WiFi at home to use for virtual training?  

Yes
No
Required 27.

What social media sites do you use? 

Facebook
Instagram
Twitter
Other  
28.
How did you hear about the ApprenticeshipWorks Program? (check only one)
From a friend or relative
From The WorkPlace website
From the newspaper
From a flyer
From an employer
Referral from another program
From an elected official
From another source (please list the specific source in the Comment area below).
  • Comment:

  • 500 characters left.