Work-Based Learning Application(Apprenticeships and On-The-Job-Training)

Work-Based Learning Application

(Apprenticeships and On-The-Job-Training)

Please fill out the information below and look for a follow-up email about the next steps!

Social Security Number*

Primary Phone*

Phone

Demographic Information

What is your current age?*

What is your gender?*

Select

Please select your citizenship status*

I am a U.S. citizen

I am not a U.S. citizen

I am a permanent resident

Selective Service*

Yes

Not Applicable (females only)

Are you married?*

Married

Single

Are you an English language learner?*

Yes

Are you a veteran?*

Yes

Are you the spouse of a member of the armed forces*

Yes

Disabilities and Related Conditions

Please select which disability status applies to you.*

Low Income Eligibility

Please select which foster home situation applies to you*

Currently in foster care

Aged out of foster care

Never in foster care

Are you an ex-offender or have you been arrested or convicted of a crime*

This includes DUI and DWI charges

Yes

Have you or an immediate family member received TANF or cash assistnace within the last 6 months?*

Yes

Have you or an immediate family member received SSI (Supplemental Security Income) within the last 6 months?*

Yes

Have you personally received Supplemental Security Disability Insurance within the last 6 months?*

Yes

Have you or a family member received food stamps (SNAP) within the last 6 months?*

Yes

Are you homeless?*

Yes

What is your household monthly income?*

What was your TOTAL household income for the previous 6 months? (This will be verified, so please be as accurate as you can)*

How many family members live in your household? (Include yourself)*

Have you found employment with your current skills or work experience that leads to self-sufficiency?*

Yes

Are you unlikely to return to a job at self-sufficient wage?*

Yes

Are you pregnant or parenting and between the ages of 16-24?*

Yes

Are you Currently Working?*

Yes

What is your hourly rate of pay?*

How far are you willing to travel for work?*

Up to 5 miles

Up to 10 miles

Further than 10 miles

What shifts are you willing to work?*

Day

Evening / Swing

Night / Graveyard

Please select which training program you are interested in*

Select

Are you currently enrolled in school?*

Yes

Did you drop out of high school and not return?*

Yes

Are you currently attending an adult education center or online school?*

Check yes if you are not at a public school but still earning your GED or High School Diploma

Yes

What is the name of the school?*

What is the name of the training program?*

What is the anticipated graduation date?*

What is the highest grade you've completed? (0-12)*

Select or enter value

Please list any additional licenses or certificates you have*

What Pell Grant situation applies to you*

I have not applied for Pell

I have applied for Pell and am waiting

I have been awarded the Pell grant

Dislocated Worker Eligibility

Were you laid off/terminated from your last job?*

Yes

Are you long term unemployed? (27 or more consecutive weeks)?*

Yes

Job of layoff hourly wage*

Are you currently receiving Ra/unemployment benefits?*

I am a claimant

I have exhausted my unemployment

I have neither claimed nor exhausted my unemployment

Have you applied for Ra/unemployment but are waiting for it to start?*

Yes

What is the date of your last Ra/unemployment payment?*

Have you worked or earned wages since exhausting your Ra/unemployment?*

Yes

Have you been able to find employment with current skills that leads to self sufficiency?*

Yes

Are you a self employed individual who has lost your employment contract or business earnings due to the economic downturn and has been unable to find employment or replace your business earnings?*

Yes

Are you an individual who has been providing unpaid services to a family member in the house while being dependent on income from another family member?*

Yes

Are you no longer supported by the income of the family member and are facing difficulty in obtaining or upgrading employement?*

Yes

Are you a dependant spouse of a member of the armed forces on active duty and whose family income is greatly reduced because of deployment, a call to active duty, permanent change of station or service connected to death or disability of the member?*

Yes

Are you a spouse of a member of the Armed Forces on active duty and whose family income is significantly reduced because of relocation to accommodate a permanent change in duty station?*

Yes

Are you the spouse of a member of the armed forces and is unemployed/underemployed and is experiencing difficulty in obtaining or upgrading employment?*

Yes

Are you a recently separated service member with a honorable discharge who has received a notice of separation within the past 48 months who is unlikely to return to a previous industry or occupation?*

Yes

MUST READ BEFORE SUBMISSION

After submitting the application, you will receive an email within 24 hours explaining the following 5 steps that take place in Employ Florida, a statewide job and training assistance website. Type "I understand" next to each step that you will complete after submitting this application.

STEP 1: Make an Employ Florida registration at employflorida.com*

Please type "I understand"

STEP 2: Upload or create a resume in Employ Florida*

Please type "I understand"

Step 3: Complete the background wizard in Employ Florida*

Please type "I understand"

Step 4: Complete the work analyzer in Employ Florida (this is a short career assessment)*

Please type "I understand"

Step 5: Upload a picture of your ID and Social Security Card in Employ Florida. (Or come to our location to make copies)*

Contact Information

Demographic Information

Disabilities and Related Conditions

Low Income Eligibility

Employment History

Education History

Dislocated Worker Eligibility

MUST READ BEFORE SUBMISSION