CareerWORKS APPLICATION

Today's Date(required)

First Name(required)

Last Name(required)

Home/Cell Phone(required)

Alternate Phone

Email(required)

City(required)

Are you at least the age of 18 or over?(required)

Yes

No

Current age (All ages welcome! This helps us determine if you are also eligible for other programs we have)(required)

There are many ways to be eligible for CAREERworks. Please mark all that apply regarding your eligibility. Mark “Other” if your situation is not listed: (required)

Loss of a job through no fault of your own (ex. Laid off)

Contract is ending or has ended

Notified that you will be losing your job

Unemployed and eligible, using or have already exhausted unemployment benefits

Transitioning Military/Unemployed veteran

Dislocated Military Spouse – Loss of a job due to relocation

Other/Not sure

Please explain your employment situation:(required)

Prior to the creation of CAREERworks-Able2work, our organization has given priority to Veterans and persons with disabilities through our other grant programs. Please mark all that apply: (required)

I am a Veteran

I am a person with a disability

Not Applicable

What is your highest level of education completed?(required)

Year graduated (please write n/a if you have never graduated high school)(required)

Are you currently attending school?(required)

Yes

No

If so, what is your expected graduation or completion date?

What career/position/field of interest are you looking for?(required)

What can we assist you with at CAREERworks? (required)

I am looking for immediate direct employment & financial support services only

I am looking to find employment while attending a certification training (CompTIA, Excel, Business)

I am looking for immediate direct employment & financial support services, but interested in having access to training materials

I am looking to find employment and assistance for test fee coverage for a certification/license outside of CAREERworks training

other/unsure

How did you hear about our program?(required)

Email address(required)

A-DA Programs