OJT Education & Training
Application for Culinary Training Class
Applicant Name: *
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Applicant's Birthday: *
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Applicant's Race:
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Applicant's Sex:
Applicant's Address: *
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City: *
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State: *
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Zip Code: *
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Applicant's Home Phone:
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Applicant's Mobile Phone:
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Applicant's Email:
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Name of Emergency Contact: *
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Emegency Contact's Relationship to You: *
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Emergency Contact's Address: *
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Emergency Contact's Home Phone Number: *
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Emergency Contact's Work Phone Number:
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Emergency Contact's Cell Phone Number:
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Emergency Contact's eMail Address:
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Disability:
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Name of VR Counselor: *
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VR Counselor Phone Number: *
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Month in which you applying for:
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If your first choice of Training Class if full, would you like to be considered for a future class?:
Highest grade completed in school:
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Do you have any limitations that prohibit you from performing certain tasks?
If yes, Please explain:
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High School Attended:
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City:
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Grade Date:
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College/Vo-Tech
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Degree/Certificate earned:
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Date:
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Employment Goal after Training: *
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Please complete this questionnaire so that we may best meet your individual needs while enrolled in our program. *
Please pick one option (If you picked option 2-Please explain in option 2)
List all prescription and non-prescription medications that you are taking
Explanation of Option 2
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Check any of the following that you may require to meet your needs during the training:
List any physical limitations you may have:
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Please list any questions or concerns we can assist you with while enrolled in our program.
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Have you ever been convicted of a felony ?
If yes, explain:
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Please tell us a little about yourself and what you like to achieve from our program:
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I certify that all of the above information is true and correct, to the best of my knowledge. I understand that falsifying application information could result in dismissal from the program and any employment connected with OJT. I also understand that I may be required to complete and pass a drug screening prior to starting the program *
Sign and date
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