Pre-Apprenticeship Intake Form

First Name *

Last Name *

Address 1 *

Address 2

City *

State/Province *

Zip *

Phone *

Email *

Gender *

Race/Ethnicity *

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Hispanic/Latino
Prefer not to say

How did you hear about the program? *

Are you at least 18 years of age? This is a requirement. *

Are you legally authorized to work in the U.S. on a full-time basis? This is a requirement. *

Do you have a high school degree/GED? *

If in progress, expected date of completion:

Highest Education Level *

Are you a Veteran? *

Will you now, or in the future, require sponsorship for employment visa status? *

Are you available to attend part-time training online and in-person? *

Are you currently employed? *

If employed, what is your hourly wage? *

If employed, how many hours a week, on average, do you work? *

Please list below a brief work history, starting with your current or most recent employer:

Employer 1 *

Employer 1 Location: *

Employer 1 Position/Job Title: *

Employer 1 Hours Per Week: *

Employer 1 Starting Date: *

Employer 1 Ending Date: *

Employer 1 Reason For Leaving: *

Employer 2 *

Employer 2 Location: *

Employer 2 Position/Job Title: *

Employer 2 Hours Per Week: *

Employer 2 Starting Date: *

Employer 2 Ending Date: *

Employer 2 Reason For Leaving: *

What are you most hoping to learn in this program? *

Please list below the names, titles, phone numbers and email addresses for 2 professional references. (This is not a requirement for this program, but we encourage you to consider who might serve as a reference)

Reference 1 Name: *

Reference 1 Title: *

Reference 1 Email: *

Reference 1 Phone: *

Reference 2 Name: *

Reference 2 Title: *

Reference 2 Email: *

Reference 2 Phone: *

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Pre-Apprenticeship Intake Form