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!

Contact Information

County*
Phone


Demographic Information

Select
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Please select your citizenship status*
Selective Service*
Are you married?*
Are you an English language learner?*
Are you a veteran?*
Are you the spouse of a member of the armed forces*


Disabilities and Related Conditions

Please select which disability status applies to you.*


Low Income Eligibility

Please select which foster home situation applies to you*
Are you an ex-offender or have you been arrested or convicted of a crime*

This includes DUI and DWI charges

Have you or an immediate family member received TANF or cash assistnace within the last 6 months?*
Have you or an immediate family member received SSI (Supplemental Security Income) within the last 6 months?*
Have you personally received Supplemental Security Disability Insurance within the last 6 months?*
Have you or a family member received food stamps (SNAP) within the last 6 months?*
Are you homeless?*
Have you found employment with your current skills or work experience that leads to self-sufficiency?*
Are you unlikely to return to a job at self-sufficient wage?*
Are you pregnant or parenting and between the ages of 16-24?*


Employment History

Are you Currently Working?*


Education History

Select
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Are you currently enrolled in school?*
Did you drop out of high school and not return?*
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

Select or enter value
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What Pell Grant situation applies to you*


Dislocated Worker Eligibility

Were you laid off/terminated from your last job?*
Are you long term unemployed? (27 or more consecutive weeks)?*
Are you currently receiving Ra/unemployment benefits?*
Have you applied for Ra/unemployment but are waiting for it to start?*
Have you worked or earned wages since exhausting your Ra/unemployment?*
Have you been able to find employment with current skills that leads to self sufficiency?*
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?*
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?*
Are you no longer supported by the income of the family member and are facing difficulty in obtaining or upgrading employement?*
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?*
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?*
Are you the spouse of a member of the armed forces and is unemployed/underemployed and is experiencing difficulty in obtaining or upgrading employment?*
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?*


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.



Please type "I understand"

Please type "I understand"

Please type "I understand"

Please type "I understand"