Amped Advanced Technology Certification Training

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Name* This field is required.
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Race
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How did you hear about us?* This field is required.
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How did you hear about us?* This field is required.
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Tell us what brings you here today?* This field is required.
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What is your highest level of education or training?* This field is required.
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To comply with federal regulations, such as Section 503 of the Rehabilitation Act, we invite you to voluntarily self-identify if you have a disability. This information is confidential and will be used solely for affirmative action reporting purposes, as required by law. It will not be used in hiring decisions. Do you have a disability, as defined under federal law (a physical or mental impairment that substantially limits one or more major life activities, a record of such impairment, or being regarded as having such an impairment)?* This field is required.
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What is your current employment status?* This field is required.
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If Employed, What is your Industry and Job Title?* This field is required.If it does not apply, please mark N/A
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What was your Job Title
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List Previous EmploymentNot your current employment
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What is your current household income?* This field is required.
$0-$20,300
$20,301-$32,150
$32,151-$43,150
$43,151-$54,150
$54,151-$69,600
$69,601-$83,500
$83,501-$102,050
$102,051 or more
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Number of people living in household (all children and adults)* This field is required.
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List any previous IT Training you have received
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List any certifications or training programs you have completed related to technology * This field is required.
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Are you willing to commit to this 18-week training?* This field is required.
YESNO
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If selected for this program, do you need to give a leave notice to a current job in order to participate in this training?
YESNO
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Do you believe you would pass a drug screening based on your current lifestyle and choices?* This field is required.
Yes
No
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Do you believe you would pass a drug screening based on your current lifestyle and choices?* This field is required.
YESNO
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Are you willing to undergo a drug test as part of an employer's hiring process?* This field is required.
Yes
No
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Are you willing to undergo a drug test as part of an employer's hiring process* This field is required.
YESNO
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Have you ever been convicted of a felony?* This field is required.
YESNO
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Have you ever been convicted of a felony or misdemeanor, and if so, please provide details including the nature of the offense, date, and any relevant circumstances? Please note that while we accept participants regardless of criminal background, a criminal history may pose challenges in securing employment after program completion
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Why are you interested in this opportunity?* This field is required.
Please ensure the link to your video is accessible.
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Have you participated in any community programs?
Please list the program(s)
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Any additional skills, experience or information you would like to provide?
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