Job & Leadership Training Application
Instructions: Please complete all questions and then click "Submit." The Job & Leadership Training staff will review your application and will call you to schedule an interview if you fit our target criteria. Please call 314.371.2700 if you have any questions.
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First Name *
Last Name *
Phone Number *
Backup Phone Number
Address *
Zip Code *
Email Address
Birth Date *
MM
/
DD
/
YYYY
Race/Ethnicity *
Marital Status *
Are you currently enrolled in School? *
What is the highest level of high school you have completed? *
Have you completed any higher education? *
What is your total taxable monthly income? *
(i.e. from working)
What is your total monthly income from government assistance? *
(i.e. food stamps, TANF, etc.)
Work History
Please list 2 most recent jobs. If you don't have any work history, write "None" in all of the boxes.
Place of Employment #1 *
(most recent job)
Start Date *
End Date *
Start Pay *
End Pay *
Position *
Reason for Leaving *
Place of Employment #2 *
(most recent job)
Start Date *
End Date *
Start Pay *
End Pay *
Position *
Reason for Leaving *
Legal & Health
The answers to the following questions will be kept confidential. PLEASE ANSWER HONESTLY. Your responses will not necessarily disqualify you from being a candidate for the program.
Do you have any felonies on your record? *
If yes, for what?
Are you on probation or parole? *
If yes, why?
P&P Officer/District
P&P Officer's Phone Number
P&P Officer's Email
Have you been diagnosed with any mental health conditions? *
If yes, what?
If yes, are you currently taking medication(s) or receiving treatment?
Clear selection
Do you have any disabilities? *
If yes, describe:
Are you currently drug-free? *
Final Questions
Are you involved in any structured activities? *
(i.e. sports team, church, music group)
If yes, please list them:
How many other job training programs have you participated in? *
write a #
If yes, which ones?
How did you hear about this program? *
Submit
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