Preliminary Application for Eligibility
Email address *
Today's Date *
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Instructions for Eligibility Determination
Complete Eligibility Form. Type N/A for areas that do not apply to you. Locate supporting documents and send them in an email to crdapplications@gmail.com or bring copies to Career Resource Department

Supporting Documents:
*United States Citizen: Birth Certificate
*Legal Alien:Employer Authorization card or Residency card(copy of both sides)
*Social Security Card
*School ID, California Driver License, or California ID (Picture ID must be valid,expired or old schools ID will not be accepted)
*Selective Service registration (if male 17 1/2 or older)
*Proof of Family size:
-Copy of All Social Security Cards
-Copy of All Birth Certificates
*Proof of Income (1 of the following)
-TANF-Passport to Services printout form Department of Human Services (Must be current month to reflect past six months of application date)
-Food Stamp verification (Notice of Action must be current month or passport to services)
-Unemployment verification (UIB Stub or printout)
-Payroll verification for the past six months (for everyone employed in the household)

If you have any questions concerning eligibility or have difficulty locating any documents please contact the Career Resource Department staff at: 661-322-7492.

Student Information
Name *
First and last name
Your answer
Phone Number *
Home Phone Or Cell Phone
Your answer
Email *
Please give us your email one more time.
Your answer
Birth Date *
MM
/
DD
/
YYYY
Age *
Your answer
Social Security Number *
Your answer
School
Your answer
Home Address
Street *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Mailing Address
If Address is same leave this section blank
Street
Your answer
City
Your answer
State
Your answer
Zipcode
Your answer
Emergency Contact 1
Name *
Your answer
Phone Number *
Your answer
Relationship *
Your answer
Street *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Emergency Contact 2
Name *
Your answer
Phone Number *
Your answer
Relationship *
Your answer
Street *
Your answer
City *
Your answer
Zip Code *
Your answer
WIA Participation
Did you previously particpate in a WIA program? *
If YES, please provide name of school, year attended ,and the program name.
Your answer
Are you a high school graduate? *
If NO, what is the highest grade you completed.
Your answer
Are you attending school now? *
If YES, please provide school name, current year in school, and GPA(approximate)
Example: Bakersfield Adult School, Senior, 3.20 GPA
Your answer
Income
Does your family receive public assistance(i.e. TANF)? *
Are you receiving food stamps? *
General
Do you live with your parents? *
If NO, with whom do you live with and what is their relationship to you
Example: Mary Smith, grandmother
Your answer
Are you a United States citizen? *
If NO, Are you eligible to work?
If YES, what is you INS card#?
Your answer
If male(17 1/2 or older), are you registered with the selective service?, female click other and type female. *
If you answered NO to the previous question may we register you for selective service? * If you chose NO, you will not be approved for the program for which you are applying due to federal regulations. *
Do you have a disability(learning, physical, mental)? *
Are you teen parent or pregnant? *
Do have any children? *
If yes, how many and what are their ages?
Your answer
Are you on probation of any sort? *
Are you currently in foster care or previously been in foster care? *
Do you have a probation officer or Social Worker *
Probation officer or Social Worker Name
Your answer
Probation Officer or Social Worker Phone Number
Your answer
Please list all persons living in your household and any persons who resided in your household during the past six months. Be sure to include their GROSS(before deductions) monthly income and income source. For example, name of company, TANF, unemployment, disability, social security. *
Sample: Name, Relationship, Age, Source of income, Gross Monthly Income, Still In Household (Yes or No) Example: Mary Smith,54,mom,job,$2000,yes Dave Smith,56,dad,unemployed, $1200,yes
Your answer
Write something about yourself. Why would you like to have job? Where would you like to work? What are your plans for the future? *
Your answer
Alternate contact information (must not be someone currently living with you)
Name *
Your answer
Phone Number *
Your answer
Relationship *
Your answer
Street *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Alternate contact information (must not be someone currently living with you)
Name
Your answer
Phone Number
Your answer
Relationship
Your answer
Street
Your answer
City
Your answer
Zipcode
Your answer
Please select which vocational training you are interested in (You can choose more than one). Vocational training available for out of school applicants 18 years and older. *
Required
Notes
The Kern High School District prohibits discrimination, harassment, intimidation, and bullying based on actual or perceived ancestry, age, color, disability ,gender, gender identity,gender expression, nationality,race or ethnicity, marital,parental or family status, religion,sex(sexual harassment,sexual orientation, or association with a person or group with one or more of these actual or perceived characteristics. For concerns or complaints regarding this policy, please contact Human Resource Administrator Kevin Platt-Equity/Titile LX Compliance Officer-5801 Sundale Ave. Bakersfield, CA 93303- 661-827-3160
A copy of your responses will be emailed to the address you provided.
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