WARD 8 WORKS PARTICIPANT PROFILE
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PARTICIPANT INFORMATION
Name: *
Date of Birth:
MM
/
DD
/
YYYY
Phone:
Phone Type:
Current Address:
City:
State:
Zip Code:
Ward:
Clear selection
Email Address:
Do you have a government-issued ID?
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Do you have dependents?
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If yes, do they live with you?
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Last 4 Digits of Social Security Number:
EMERGENCY CONTACT
Name of a Person Not Living With You:
Contact Phone:
Contact Address:
City:
State:
Zip Code:
Relationship to You:
EDUCATION INFORMATION
Highest Grade Completed:
Earned GED or HS Diploma?
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Some College?
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Do you have any construction-related training?
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Do you have any construction-related certifications?
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If yes, list below.
PUBLIC ASSISTANCE
Do you receive any of the following types of support? (Check all that apply.)
BARRIERS
Of the following, what challenges below make it difficult for you to work? (Check all that apply.)
SERVICE PROVIDERS
Have you received services or participated in programs with the following agencies in the last 12 months? (Check all that apply.)
EMPLOYMENT INFORMATION
Are you currently employed?
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Length of Time on Current Job:
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Employer Name:
Employer Telephone Number:
What are your best working hours? (Check all that apply.)
List 3 Personal Strengths: (What are you good at?)
List 3 Personal Challenges: (What things do you need to work on?)
WORK EXPERIENCE
Do you have any construction experience in any of the following areas? (Check all that apply.)
PRIVACY DISCLOSURE:
All information provided on the Ward 8 Works Participant Profile is voluntary and will become a part of an electronic W8W Cohort Tracking system which will be maintained on the DMPED computer server.  

By providing information on this form, you hereby consent to the information being shared with the Ward 8 Works Core Group which is made up of federal and local government agencies, nonprofits, developers and contractors responsible for connecting participating residents with  employment opportunities on Ward 8 development projects.  

Information contained in the electronic W8W Cohort Tracking system may also be used to track, monitor and provide other supportive services to participants.  Participants may always choose to accept or decline any employment or additional supportive services offered.  
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