GCKAG Workforce Preparedness Registration
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Email *
First Name *
Last Name *
D.O.B. ( Must be 18 + to enter the program) *
Street Address *
City *
ZIP Code *
Phone - Please provide the best number to reach you *
Employment Status *
Required
Education - Please indicate highest grade completed. *
Required
Computer Skills
Indicate your computer skills below
How comfortable are you with understanding basic computer use?  (i.e., logging on, search the web, email, etc.) *
Not Comfortable
Very Comfortable
How comfortable are you with Microsoft Office? (i.e., Word, Excel, PowerPoint, etc.) *
Not Comfortable at All
Very Comfortable
Background Check
We are required to do a background check for all participants.  Having a criminal background does NOT eliminate you from program participation, so please answer the following questions honestly.  
Are you on the Federal Sex Offenders Registry? *
Covid-19 Vaccination Status
We required in person participants to be fully vaccinated.  Please indicate your vaccination status and email a copy of your card to fsmith@rbpcdc.org.  We must receive a copy of your vaccination record prior to attending any in-person class.  Please note that all students and staff will be required to wear a mask during the in-person sessions.  If you are not vaccinated and do not plan to be, you may only attend the virtual course sessions and not the in-person sessions.
I have received the Pfizer (two doses), Moderna (two doses), or the Johnson and Johnson (one dose plus booster) Covid 19 Vaccination and I am fully vaccinated.   *
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