CAP Application
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Please choose a location:
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Which class are you interested in: *
Today's Date *
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Last Name *
First Name *
Middle Name *
Birth Date *
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Home Address *
Mailing Address (if different from home) *
Apartment/ Unit # *
City *
State *
Zip Code *
Cell Phone *
Home Phone *
Email Address *
Who referred you? *
What is your race? *
What is your current gender identity? *
Are you a citizen of the United States?
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If no, are you authorized to work in the United States? *
Are you a veteran? *
How did you hear about the Chatham Apprentice Program (CAP)? *
Applicant's marital status: *
What is the primary language spoken in your household? *
Emergency Contact: Please list a relative or friend who would definitely know how to contact you, even if you move. (Name and Phone) *
Do you have a High School Diploma/GED? *
What is the highest degree or level or level of school you completed?  If currently enrolled, the highest degree received. *
Required
Please list any credentials you have: *
Do you / your family have any special needs staff should know about? *
Do you receive or is someone in your house receiving, any of the following: TANF, Medicaid, SNAP/ EBT, SSI/ Social Security, and another source of income or public assistance? *
Please check the amount closest to your yearly income: *
Required
Are you currently employed? *
How many months have you worked in the past year? *
Name of Company *
Status: *
Required
What is the start date of the current job? *
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What is the end date of the current job? *
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Rate of Pay: (Current Job) *
Reason for leaving the current employment? *
Name of Company *
Status: *
Required
What is the start date of the previous job? *
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What is the end date of the previous job? *
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Rate of Pay: ( Previous Job) *
Reason for leaving the previous job: *
What job skills do you have? ( Please check all that apply) *
Required
What career field are you interested in? *
Please write at least THREE COMPLETE SENTENCES explaining your goals for this program *
Which of the following reasons have prevented you from steady employment? (Please check all that apply) *
Required
Have you ever been convicted of a felony? *
Do you currently have pending charges? *
Are you a registered sex offender? *
Are you currently on probation or parole? *
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