Application
Please answer the following questions to the best of your ability. A career counselor will contact you shortly and discuss your eligibility.
Email address *
Full Name (First, Middle and Last)
Address (Example: 537 Brite Way, APT A8, Bakersfield CA 93309)
Primary Phone Number
Alternate Phone Number
Age
Birth Date
MM
/
DD
/
YYYY
Have you previously participated in a WIA program?
Clear selection
If you previously participated in a WIA program... Where did you attend?
If you previously participated in a WIA program... What year did you attend?
If you previously participated in a WIA program... What program did you attend?
Are you a High School Graduate?
Clear selection
What high school did you attend and what year did you graduate?
If you are not a high school graduate... What is the highest grade you completed?
Are you attending school now?
Clear selection
If you are attending school now... Where are you enrolled?
If you are attending school now... What year in school are you?
If you are attending school now... What is your approximate GPA?
Clear selection
Does your family receive any public assistance?
Clear selection
Are you receiving food stamps?
Clear selection
Do you live with your parents?
Clear selection
If you don't live with your parents... Who do you live with?
If you don't live with your parents and live with someone else... what is your relationship to them?
Are you a United States citizen?
Clear selection
If you aren't a United State Citizen are you eligible to work?
Clear selection
If you are Male (17 1/2 years of age or older), are you registered with the selective services?
Clear selection
If you are not registered for selective service- may we register you? NOTE- Federal Regulations will require you to register to be eligible for our programs.
Clear selection
Are you a teen parent or pregnant?
Clear selection
If you are a teen parent...How many children do you have?
What are the ages of all of your children?
Are you on probation?
Clear selection
What is the name and phone number of your probation officer or social worker?
Write something about yourself. Why would you like to have a job? Where would you like to work? What are your plans for the future?
What vocational training program are you interested?
Alternate Contact Information... Name
Alternate Contact Information... Relationship
Alternate Contact Information... Address, City, and Zip
Alternate Contact Information... Phone
Submit
Never submit passwords through Google Forms.
This form was created inside of Kern High School District. Report Abuse