Regional Apprenticeship Development & Readiness (RADAR) Grant Program Registration

In order to participate in the Regional Apprenticeship Development & Readiness (RADAR) Workforce Grant Program this form must be completed in its entirety. For any questions regarding details of the Grant Program please contact: Project Director Sommer Edwards, sedwards@working-solutions.org

CANDIDATES MUST BE 18 AND LIVE OR RECIEVE TRAINING IN ONE OF THE FOLLOWING COUNTIES; HERKIMER MADISON, ONEIDA, FULTON, MONTGOMERY, SCHOHARIE, CHENANGO, DELAWARE, OTSEGO, CORTLAND OR ONONDAGA.

If you are experiencing difficulties or need assistance registering, or have any other questions please contact: Case Manager Sarah Roby, sroby@working-solutions.org

This workforce product was funded by a $2,999,993.00 grant 100% funded by the U.S. Department of Labor and Administered by the Apprenticeship Building America (ABA) Grant Program. This product was created by the recipient and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warrantee, or assurances of any kind, express or implied, concerning such information, including any information linked sites and including, but not limited to, the accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability or ownership. This product is copyrighted by the institution that created it. Equal Opportunity Employer/Program. Auxiliary aids and services are available upon request to individuals with disabilities.

RADAR is an Equal Opportunity Program. Auxiliary aids and services are available upon request to individuals with disabilities.

Participants Must Check Yes to Enroll*

In order to qualify for this program, the individual must self-attest to having experienced at least one condition on the ADA list at any point in time; no documentation is required.

Please check YES if you have experienced any of the conditions listed below;

Addison's Disease, Aging, Albinism, Alcoholism, Allergies, Alzheimer's Disease, Amputation, ALS, Anxiety, Arthritis, Ataxia, ADHD, Auditory Processing Disorder, Autism Spectrum, Back Impairment, Bipolar Disorder, Bladder Impairment, Bleeding Disorder, Blindness, Body Odor, Brain Injury, Burn Injury, Cancer, Cataplexy, Cerebral Palsy, Charcot-Marie-Tooth, Chronic Fatigue Syndrome, Chronic Pain, Colorblind, COVID-19, Cumulative Trauma Conditions, Deafness, Depression, Diabetes, Drug Addiction, Dystonia, Eating Disorders, Ehlers-Danlos Syndrome, Electrical Sensitivity, Epilepsy, Essential Tremors, Fetal Alcohol Syndrome, Fibromyalgia, Food Allergy, Fragrance Sensitivity, GERD, Gastrointestinal Disorders, Graves; Disease, Guillain Barre' Syndrome, Hand Amputation, Hearing Impairment, Heart Condition, Hepatitis, HIV, Huntington's Disease, Intellectual Impairment, Latex Allergy, Learning Disability, Little Person, Long COVID, Low Vision, Lupus, Lyme Disease, Marfan Syndrome, Mental Health Conditions, Migraines, Multiple Chemical Sensitivity, MS, Muscular Dystrophy, Myalgia Encephalomyelitis, Myasthenia Gravis, Obesity, OCD, Paraplegia, Parkinson's Disease, Personality Disorder, Phobias. Polio, PTSD, POTS, Pregnancy, Quadriplegia, Raynaud's Disease, RSD, Renal/Kidney Disease, Respiratory Impairments, Sarcoidosis, Schizophrenia, Seasonal Affective Disorder, Shingles, Sickle Cell Anemia, Skin Conditions, Sleep Disorder, Speech-Language Impairment, Spina Bifida, Stroke, Stuttering, Thyroid Disorders, Tourette Syndrome, Vertigo

To address the need for workers in critical segments of the regional economy and provide individuals with disabilities opportunities they currently lack to enter apprenticeships, the Workforce Development Board of Herkimer, Madison and Oneida Counties has developed the silo-smashing Regional Apprenticeship Development and Readiness (RADAR) project to unite agencies that serve individuals with disabilities with the workforce system, training providers and employers to provide not just equity, but opportunity.

Yes

Does your disability affect your ability to function and require workplace accommodations?*

Yes

Please describe any accommodations in the box below*

First Name*

Last Name*

Date of Birth*

Gender*

Male 1

Female 2

Prefer not to say 9

Are you registered with the Selective Service?*

If you are unsure you can check here: https://www.sss.gov/verify/

Yes

Social Security Number*

The information will be used to collect quarterly wage data for the purposes of assessing the overall performance outcomes of a grantee and of the program.

Street Address*

Please be sure to include YOUR mailing address.

City*

State*

Zip Code*

Phone Number*

Please be sure to include YOUR phone number so we are able to contact you regarding your services.

Email*

Please be sure to include YOUR e-mail address so we are able complete your enrollment and correspond with you regarding your services.

Do you have a Drivers License?*

Yes

U.S. Citizen*

Yes

If you are NOT a US citizen, are you authorized to work?*

Yes

Are you currently Employed?*

Yes

Employment Start Date*

Employer Name*

What is your current Job Title?*

Are you currently employed Full Time or Part Time?*

Full Time

Part Time

Please indicate your current hourly wage*

$0.00 HR

Are you Underemployed as defined below?*

A person is underemployed if they are not currently connected to a fulltime job commensurate with the individuals level of education, skills, or wage and/or salary earned previously, or who obtained only episodic, short-term or part-time employment.

Yes

Weeks Unemployed *

Are you receiving cash assistance?*

Select or enter value

Have you applied for/are you receiving Unemployment Insurance Benefits?*

Yes

Ethnicity*

Hispanic or Latino

Not Hispanic or Latino

Prefer Not to Answer

Marital Status*

Single

Married

Dependent Children*

Yes, under 6

Yes, under 18

Yes, older disabled

Current School Status*

In Highschool 1

In College 3

Over 18 - Not in Highschool - No Diploma 4

Over 18 - Not in Highschool - Received Diploma/Equivalent 5

Under 18 - Not in Highschool - No Diploma 6

Military Service*

Yes

Active Service Dates

Have you ever been arrested or convicted of a crime?*

Disclosure of criminal history will not prevent an individual from receiving services. These questions are asked to ensure that our staff can assist you in navigating any barriers to your desired education or employment goals.

Yes

Career of Interest *

RADAR can assist in the following fields; Trades, Manufacturing, IT/Cybersecurity and Direct Support Professional.

Referred By*

Supportive Service Comments*

Please include the following;

Your primary language
If you are receiving services from another program or organization
If you are in need of any specific supportive services

Authentication

By submitting this form I certify that the above information is accurate to the best of my knowledge.

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