iCan! Work Application

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Thank you for your interest in the Down Syndrome Foundation of Florida's iCan! Work Program. This program allows our employees with Down syndrome to gain meaningful skills and work experience through workshops, on-the-job training with a coach and more.

If you have any questions, please email LeeAnn at LeeAnn.Quintas@dsfflorida.org - thank you!

First Name: *

Last Name: *

Date of Birth *

Address 1: *

Address 2:

City: *

State: *

Zip *

County *

Phone Number: *

Email: *

Parent's First Name: *

Parent's Last Name: *

Why do you want to participate in our iCan! Work program? *

Have you applied for services with the Agency for People with Disabilities (APD) in the state of Florida? *

Yes

Are you currently on the APD wait-list in the state of Florida? *

Yes

Do you currently receive APD funding? *

Yes

If yes, for what services?

Are you currently registered with Vocational Rehabilitation (VR)?

Yes

In Process

Clear selection

Have you ever received services from VR? *

Yes

What services do you currently receive with VR or if not currently receiving them, what have you received in the past? Please state clearly if the services are current or in the past.

Do you receive any other funding from private/government sources? *

Yes

If yes, please explain.

Name of high school attended. *

What year did you graduate? *

Are you currently employed? *

Yes

If no, have you ever been employed? *

Yes

If you have been employed, please tell us about your work experience.

Do you do any volunteer work in the community? *

Yes

If yes, please explain what kind of volunteer work.

What is your work availability *

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Morning

Afternoon

Evening

Unavailable

Do you have a reliable source of transportation to your work location? *

Yes

I do not know

What type of work environment would be interesting to you? *

I am interested in working at ORLANDO HEALTH ( Variety of opportunities available)

I am interested in the Orlando Magic games at the KIA Center.

I am interested in the WHITE CASTLE position.

Industry (assembly line, office work, etc.)

Law office (clerical work)

Restaurant (bussing tables, waiting on customers, etc.)

School (front desk, cafeteria, maintenance, etc.)

Other...

Required

If you selected other please explain.

If you selected ORLANDO HEALTH, what location is closest to you?

What is your dream job? *

What are your employment goals? *

What is your reading level? (Reading is not a prerequisite for the iCan! Work Program, it just helps us find the best match for your interests and abilities. The FOUNDATION provides scholarships for tutoring if your applicant would like to improve their reading skills.) *

Beginning (can read simple books and instructions with some help)

Moderate (can read chapter books and instructions independently)

Advanced (can read most things without any assistance)

I do not read

Other: please explain

What are your primary interests (hobbies and/or job interests)? *

Comments:

I am a member of The FOUNDATION.

I am NOT a memeber of The FOUNDATION

Required

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