Project Excite H-1B Grant Program Registration

In order to participate in the H-1B One Workforce Grant Program this form must be completed in its entirety. For any questions regarding details of the Grant Program please contact: Project Director Alan Lam, alam@working-solutions.org


CANDIDATES MUST BE OVER THE AGE OF 18 AND LIVE IN NEW YORK STATE


If you are experiencing difficulties or need assistance registering, or have any other questions please contact: Placement Coordinator Austen Johnson, ajohnson@working-solutions.org


This program is 100% funded by a United States Department of Labor H-1B One Workforce Grant of $3,206,002. 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, warranties, or assurances of any kind, expressed or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of information or its completeness, timeliness, usefulness, adequacy, continued availability or ownership. This product is copyrighted by the institution that created it.


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

XX/XX/XXXX

Gender*
Are you registered with Selective Service?*

The USDOL requires this information In order to participate in this program. If you are unsure whether or not you have been registered with Selective Service you may go to www.sss.gov/verify/ to find out.

Please select from drop down list below. Candidates outside New York State are not eligible.

Select or enter value
Caret IconCaret symbol

Please include area code in this format 000-123-1234

Phone

Select all that apply

Education level*
Are you an International Student?*

If you are an International Student please select which type of visa you have. If you are NOT an international student please select 'Not Applicable'

Please select any of the following programs you have completed*
Is English your second language?*
Are you a US citizen*
If NOT US Citizen, are you allowed to work in US*
Are you married?*
Do you have any disabilities?*
Please let us know which category your degree type falls under*
Are you currently employed?*
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.

Please indicate your yearly salary*
Part-Time, Full-Time or Self Employed? *
If you lost a job recently was it due to COVID?*
Have you been unemployed for longer than six months?*

Please leave blank if you have never worked

Have you received unemployment benefits during the last year?*
Are you a Veteran?*

Please enter with MM/YYYY to MM/YYYY

ATTENTION

The following questions are required by the United States Department of Labor for participation in this program. Participants answers WILL NOT have any effect on their eligibility or be used for any purposes other than this program

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. You will not be denied access to the program if you decline to provide your SSN.

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.

Are you currently receiving public assistance such as SNAP, SSI and/or TANF?*
Who referred you to our program?*

As a condition to my authorization the H-1B Grant Program agrees to use the information obtained solely for the purposes authorized by law and regulation determining eligibility for employment and training programs, developing an appropriate employment or self - sufficiency plan, educational training and plans, and helping me achieve my occupational and educational goals. the authorization is valid for 18 months after the date of exit from my program of services. This authorization is valid for the purpose of obtaining information for program performance reporting and participant follow up activities related to my participation in the H-1B Grant Program. I understand that, as a condition of my receiving services, information collected by the Project Excite will be used for the purposes of determining overall program performance. BY CHECKING THIS BOX I AGREE I HAVE READ AND AGREE TO TERMS ABOVE.

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

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