Production Technician Application

Production Technician

Learner/Trainee Application
Name *

First Name Middle Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
County of Residence
Phone Number *

Area Code Phone Number
Date of Birth *

Month Day Year
Date
E-mail *
Are you a resident of Maine? *

Yes No
Are you a US citizen? *

Yes No
Ethnic Group *

Not Hispanic/Latino Hispanic/Latino
Race *

American Indian or Alaska Native Asian Black or African American White Native Hawaiian or Other Pacific Islander
Gender *

Male Female Other
How did you hear about this training program?

Newspaper Email Newsletter Facebook Word of Mouth
Education (highest grade completed) *

HS Diploma, GED, or HiSet Some college/no credential Credential < 2 year or Associate degree Associate's degree Bachelor's degree Master's degree of higher
Are you currently employed? *

Yes No
If employer, who is your employer? *
If employed, do you work full-time? *
I hereby consent to the use by Washington County Community College to use a photograph of me in any publications, website, advertisement, report or other material promoting the College or the system. I hereby waive any and all rights to inspect or approve such photograph(s), and I release the College and the MCCS for any and all claims arising from use of the photograph(s).
I certify that all information on this application is accurate and complete.
Signature

Clear
Should be Empty: