CareerSource PWE (Paid Work Experience)

CareerSource PWE (Paid Work Experience)

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

Social Security Number*

Demographic Information

Date of Birth*

mm/dd/yyyy

What is your current age?*

What is your gender?*

Male

Female

Did not self-identify

U.S. Citizenship Status*

I am a U.S. citizen

I am not a U.S. citizen

I am a permanent resident

Are you married?*

Married

Single

Are you homeless or living in a shelter?*

Yes

Have you registered for Selective Service?*

Yes

Not Applicable (females only)

Are you a migrant seasonal farmer?*

Yes

Are you an English language learner?*

Yes

Are you a veteran of the U.S. Armed Forces?*

Yes

Do you have a disability?*

Yes

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 assistance 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 within the last 6 months?*

Yes

Are you receiving or have you been notified you will receive PELL grant monies?*

Yes

What is your household MONTHLY income?*

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

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

Include yourself in this number

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?*

On average, how many hours a week do you work?

Are you currently enrolled in school?*

This includes college courses, occupational training, or traditional High School (Select "no" if you are attending a GED/adult education course)

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 high 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?*

mm/dd/yyyy

What is your highest grade completed? (0-12)*

Select or enter value

IMPORTANT PLEASE READ

You MUST attend an in-person orientation that will explain the program, which employers are available, and take an assessment as a part of enrolling into this program. You will be contacted by staff concerning the available dates and locations of the orientation.

Contact Information

Demographic Information

Low Income Eligibility

Employment History

Education History

IMPORTANT PLEASE READ