MidSOUTH Training Academy - Participant Information Sheet - FOR DCFS EMPLOYEES ONLY
FOR DCFC EMPLOYEES ONLY - Please answer all the questions each time you need to take a New Staff Training. Since you may be taking one or all of your Concentration Training Units at different sites, your hotel needs might change. Some of your other information may have changed as well. We use your answers to ensure that information on your progress in training is communicated to all the appropriate people. Thank you for your help.
Last Name *
Your answer
First Name *
Your answer
Middle Name
Your answer
Type of Training Needed *
New Staff Training for FSWs - Concentrations *
Date of Employment (Hire Date) *
MM
/
DD
/
YYYY
Position/Title *
Specialized Field *
DCFS County *
DCFS Area # *
State Email Address *
Your answer
Personal Email Address *
Your answer
Home Address (Street) *
Your answer
Home Address (City) *
Your answer
Home Address (State) *
Your answer
Home Address (Zip) *
Your answer
Work Phone *
Your answer
Home Phone *
Your answer
Mobile Phone *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Immediate Supervisor's Name *
Your answer
Have you worked for DCFS in the past? *
If yes, what year were you last employed?
Your answer
Hotel Information
When you are scheduled to attend a new staff training series, you may be eligible to stay in a hotel for all or part of your training. To determine eligibility for a hotel room, you must use the shortest distance to the training site: either your official station OR your home address. If the shorter distance is 50 miles or more from the training site, a room can be provided for each day of training, excluding the last day. If the shorter distance is 100 miles or more from the training site, a room can be provided for the night before training and each day of training, excluding the last day. Based on this information, indicate if you will need a hotel room. If you do not select an option, MidSOUTH will not reserve a room for you. If MidSOUTH reserves your room, we will send you a confirmation number and the name of the hotel. If your travel plans change, it is YOUR responsibility to cancel the reservation.
Based on the above information, will you need a hotel room? *
Please indicate, depending on the information above, if you will need a hotel room the night before or morning of, based on mileage. *
If you have a disability that may have an impact on your participation in the activities of training, please provide a statement regarding your disability-related needs. We cannot assure appropriate accommodations without prior notification.
Your answer
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