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¡YouthWorks! Workforce Connect Application
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Get connected to opportunity today!
Today's Date
*
MM
/
DD
/
YYYY
Name (First + Last)
*
Your answer
Address Line One
*
Your answer
Apartment/Unit Number
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Current Phone
*
Your answer
Alternate Phone
Your answer
Email
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Age
*
Your answer
Gender
*
Your answer
Are you attending school?
*
Yes
No
Other:
If out of school are you interested in YouthWorks' GED program?
*
Yes
No
Employment History - Please briefly list your prior work experience(s). Write "n/a" if no prior work experience.
Your answer
What type of work are you interested in at this time?
*
Healthcare
Food/Restaurant Industry
Bakery
Customer Service
Hospitality
Retail
Landscaping
Environmental/Natural Resources
Agriculture
Other:
Living Situation:
*
at home/alone
with a Relative/Friend
On Street/Homeless
Transitional Living
Other (please explain in space below)
Required
Living Situation if Marked "Other" Please Explain Here:
Your answer
Family size (including adults and children):
*
Your answer
Race/Ethnicity
*
Hispanic/ Latino
American Indian or Alaska Native
Asian American
Black or African
Hawaiian Native/Pacific Islander
White
Other
Required
Which services are you seeking from ¡YouthWorks! (Choose all that apply)
*
Classroom Instruction
GED
Continuing Education
Tutoring
Case Management
Job Search Assistance Services
Resume Building
Counseling
Medical/Dental/Vision insurance/assistance
Food Assistance
Assistance with Housing
Community Service
Training
Other
Required
Other Life Needs (please specify):
Your answer
Please sign this form by typing your name followed by today's date:
*
Your answer
*Parent/guardian signature if applicant is under 18, and parent/guardian is available. Please sign this form by typing your name followed by today's date:
Your answer
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