Application for GETTING AHEAD classes

Fall session: September 12 – November 7, 2016

When: Mondays and Wednesdays, 5pm-8pm

Where: William Street United Methodist Church

Deadline for applications for the fall session is August 29, 2016.

Applications must be mailed or delivered to:

Andrews House

Attn: STEP/Getting Ahead Program

39 W. Winter Street

Delaware, OH 43015 740-369-4520

Please note: The information on this form is confidential. We will not contact your past employers or anyone else about this information. These questions are to help us select a diverse group of people in age, race, and experience who will benefit most from the classes.

You need to know: / Your commitment:
·  Filling out this form does not ensure you will be part of the next class. / ·  Attending the 17 class dinners and sessions is expected
·  You will be called to schedule a face-to-face interview. / ·  Completing all assignments and participating fully in class discussions. (This is required to receive a gift card.)
·  Decisions will be made after all interviews are conducted, and all applicants will then be notified. / ·  If you are unable to attend a class, you are responsible for contacting a facilitator prior to class and arranging to make up the work you missed.
·  Class size is limited

Name: ______Today’s Date: ______

How did you hear about the class? ______Can you commit to 16 classes? ______

Relationship Status:  Married  In a relationship  Divorced  Never married  Widowed

Address ______

Zip Code: ______County: ______Stable housing? ______

How can you best be reached?

Cell phone ______Do you prefer calls or texts? ______

Email______Work Phone ______

If you are accepted into the program, will you need transportation? ______

Will you need childcare? ______If yes, please fill in below

Children:

Age Name Lives with you? Special Needs?

______

______

______

______

______

Do you (or your children) have any special dietary needs? ______

Work History:

If you have a resume, you may attach it instead of filling out this section

Employer Position Hourly Wage # hrs/wk How long?

______

______

______

______

Employment Status:

 Currently employed  Going to school  Injury or illness, including mental health issues, is preventing me from working  Looking for work

 Other ______

  • Are you thinking about looking for another job?  Yes  No

Why or why not? ______

  • Do you have a driver’s license?  Yes  No

Education:

  • ð Some high school ð High school grad ð GED ð Home schooled ð Some college
  • ð College grad ð Post college ð Technical school
  • ð Other training/credentials ______

Sources of income: Check all that apply

 Job  Self-employed  Social Security  Child Support  Alimony  Cash benefits

 Food Assistance  Other ______

  • What’s your ‘dream job”? If there were no barriers, like money, education or distance, what job would you love to have?

______

  • How much would you like to have a “dream job”?

 Doesn’t matter that much – a job is a job  It would be nice. . .  I’d LOVE it!

 I have plans to make my dream job come true

  • What would keep you from pursuing your “dream job”?

 Education  Transportation  My family wouldn’t think it was a good idea

 I don’t think someone like me could get a job (or start a business) like that

 Other ______

What do you hope to gain from participating in “Getting Ahead”? (please include 3-4 complete sentences)______

______

For interview use only

Date of interview: ______

Interviewer: ______

Results: ______

Date applicant notified with results: ______

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