WORKFORCE PARTNERSHIP PRE-APPLICATION

WORKFORCE PARTNERSHIP

Pre-Application Information
Please select your County of residence *
Services are available only to KANSAS residents of Johnson, Leavenworth or Wyandotte counties

Are you enrolled in any school? *
Not including GED or Job Corps. Mark "No" if enrolled in GED or Job Corps

Please enter your current age *

Name *

First Name Last Name
Date of Birth *

Month Day Year
Date
What is your sex? *

Female Male I choose not to self-identify
Address *

Street Address

Street Address Line 2

City State

Zip Code
E-Mail Address *
Phone Number *

Area Code Phone Number
Phone Type *

U.S. Work Eligibility
Please select one *

U.S. Citizen Permanent Resident Authorized to Work in the U.S.
Work Authorization Number
Please select the documents you can provide to verify your Work Eligibility: *

Valid Driver's License/State ID Card Current School ID with Picture Social Security Card Birth Certificate Valid U.S. Passport Permanent Resident Card, or Other Work Authorization Document(s)

Employment Information
Are you currently working? *

Yes No
If yes:

Full-time Part-time
Employer Name, Address, Phone Number and Job Title

Applicants Under the age of 18

Parent/Legal Guardian Information is REQUIRED*
Parent/Legal Guardian Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *

Area Code Phone Number
Phone Type *

Completion and submission of this form does not guarantee eligibility for participation in any Workforce Partnership programs or services. This is a preliminary step and additional eligibility requirements apply. More information and documents must be submitted before we can determine your eligibility for specific programs or services.

Some of our services are available only to Kansas residents of Johnson, Leavenworth and Wyandotte counties, who are 16 years of age or older and not enrolled in school (such as school dropouts with no GED, or high school graduates who have not enrolled in any school beyond high school).

Please contact our office nearest you to explore the specific resources and services we may be able to offer in support of your individual career goals:

http://www.workforcepartnership.com/contact/

Thank you!
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