CAP Application
Today's Date
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Last Name
First Name
Middle Name
Birth Date
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Street Address
Apartment/ Unit #
City
State
Zip Code
Cell Phone
Home Phone
Email Address
What is your race? *
What is your current gender identity? *
Are you a citizen of the United States?
Clear selection
If no, are you authorized to work in the United States?
Clear selection
Are you a veteran?
Clear selection
How did you hear about the Chatham Apprentice Program?
Clear selection
Applicant's marital status:
Clear selection
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?
Clear selection
Name of High School?
Year Received:
Do you have a GED?
Clear selection
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 have a CDL?
Clear selection
Do you have a TWIC card?
Clear selection
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?
Clear selection
Please check the amount closest to your yearly income:
Are you currently employed?
Clear selection
How many months have you worked in the past year?
Please complete the following questions regarding your current employment?
Name of Company
Title of Position:
What is the start date of the current job?
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YYYY
What is the end date of the current job?
MM
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DD
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YYYY
Rate of Pay: (Current Job)
Reason for leaving the current employment?
Please complete the following questions regarding your previous employment?
Name of Company
Title of Position
What is the start date of the previous job?
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DD
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YYYY
What is the end date of the previous job?
MM
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DD
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YYYY
Rate of Pay: ( Previous Job)
Reason for leaving the previous job:
What job skills do you have? ( Please check all that apply)
What kind of job are you interested in working?
What kind of job are you interested in working?
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)
Have you ever been convicted of a felony?
Clear selection
Do you currently have pending charges?
Clear selection
Are you a registered sex offender?
Clear selection
Are you currently on probation or parole?
Clear selection
Clear selection
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