SECTION II- EDUCATIONAL BACKGROUND INFORMATION
SECTION III-JOB TRAINING AND WORK EXPERIENCE
SECTION IV- EMPLOYMENT HISTORY
SECTION V-PHYSICAL INFORMATION
SECTION VI-PERSONAL STATEMENT- MUST BE SUBMITTED WITH APPLICATION
SECTION VII EMERGENCY CONTACT INFORMATION
Please list two individuals we can reach in case of an emergency, and let them know you have listed them. Include cell and home phone numbers.
SECTION VIII- FINANCIAL INFORMATION
SECTION IX- CERTIFICATION AND SIGNATURE
I hereby certify that the information in this application is true and correct to the best of my knowledge. I also authorize Advancing Communities Together staff to verify this information when reviewing my eligibility for the program. I understand that I may be asked to provide documentation and agree to sign, if asked, one or more release forms to allow ACTto verify the information provided in this application.
Advancing Communities Together is an Equal Opportunity Employer/Program. Auxiliary aids, and services as available upon request for individuals with disabilities. Grant funding provided by the U.S. Department of Labor, Employment & Training Administration.
NO-INCOME CERTIFICATION **** If you have a job or if you collect government funds (Cal-WORKS, SSI, SDI, etc, do NOT fill out this form ****
I, do hereby certify that I do NOT receive income from ANY source.
I understand sources of income include, but are not limited to the following:
I certify that the foregoing information is true, complete and correct. Inquiries may be made to verify statements herein.
l also understand that false statements or omissions are grounds for disqualification from Advancing Communities Together.
Authorization for Release of Information
Name of individual or agency releasing/receiving information:
Please List (individual or agency): Advancing Communities Together
Contact Person: Rossie Cherry
Email Address: firstname.lastname@example.org
All trainees are required to attend Education and/or Vocational Instruction Monday through Friday. Friday Leadership classes are an integral part of Advancing Communities Together. In the event of illness, doctor appointment, emergency, court appearance, and any and all other absences, the following procedure must be followed in order for an "excused absence" status to be granted:
I have read the above information and agree to comply with it.
DRESS CODE POLICY
Appearance is often thought of as one of the outward signs or indications by which a person or thing is assessed. We at ACT and its members have established a culture of respect for learning in hopes of empowering all members toward achieving their personal and career goals. In doing so, it is required that all members be in dress code at all times. Failure to respect this dress code will result in not being allowed to participate in the program until they are appropriately dressed.
DRUG TEST AND RANDOM SEARCH POLICY
Please be advised that YOU ARE SUBJECT TO RANDOM SEARCHES at the discretion of the ACT Staff. POSSESSION OF CONTRABAND OF ANY SORT WILL BE RESULT IN TERMINATION PER THE MEMBER'S MANUAL. Failure to comply with a request to search your person may result in a request in a request to have a law enforcement officer-search you.
The RANDOM SEARCH POLICY is not designed to invade your privacy or accuse you of wrongdoing. Random searches will be conducted to maintain the integrity of the YouthBuild program and ensure that all YouthBuild members and staff have a safe and drug-free workplace.
Please review the DRUG-FREE WORKPLACE policy listed below:
Although Advancing Communities Together is not a drug rehabilitation program, we have a policy of maintaining Drug-Free Workplace and Environment'' In order to be an effective leader and to be successful in the workplace, in institutions of higher learning, and in life, members must be clean and sober. All members are tested for illegal drugs within the first month of the program. You may elect to waive any test, which is an admission to drug usage and will be placed on a Level I Contract. You may be randomly drug tested throughout the program.
PHOTO AND/OR VIDEOTAPE AUTHORIZATION & CONSENT
I hereby authorize staff for Advancing Communities Together to do the following:
Thank you for applying. Advancing Communities Together Staff will contact you soon. Have a great day!