OhioMeansJobs Warren County Youth Program Interest Form

  • OhioMeansJobs Warren County Youth Program Interest Form

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
  • Gender assigned at birth:*
  • What is your ethnicity?*
  • Citizenship (check all that apply):*
  • What is your race? (check all that apply)*
  • Are you legally restricted from using a computer?*
  • Relationship Disclosure - Do you have a business or personal relationship with any individual who is a: Local elected official (mayor or county commissioner); Workforce Development Board member or subcommittee member; WIOA executive, supervisor or employee;OhioMeansJobs center partner employee, WIOA sub-recipient and/or contractor; or County employee?*
  • What is your education level:*
  • Do you have work experience in Agriculture within the last 12 months?*
  • What is your current education status?*
  • Have you served in the US Military?*
  • Are you a spouse of a veteran?*
  • Are you a homeless veteran?*
  • Do you hold a valid drivers license?*
  • Are you interested in an Apprenticeship?*
  • Have you registered for Selective Service (for individuals born male, 18 or older)?*
  • Are you enrolled in ASPIRE?*
  • Have you received OWF for one or more years?*
  • Have you taken a recent math/reading assessment?*
  • Do you use recreational drugs or drink regularly?*
  • Are you a single parent?*
  • Do you think you have a cultural barrier that might hinder employment?*
  • Are you homeless?*
  • Are you a public assistance recipient (cash/food)?*
  • Are you enrolled in Vocational Rehab through OOD?*
  • Are you receiving SNAP Employment and Training?*
  • Do you have a disability?*
  • Are you a runaway?*
  • If English is not your native or primary language, do you need help learning to speak/write/use English?*
  • Are you involved or were you involved in the juvenile court or adult justice system?*
  • Are you in foster care or were you previously in foster care?*
  • Are you pregnant?*
  • Are you a parent (including noncustodial)?*
  • Are you/have you received a Pell Grant?*
  • Is your family eligible to receive free/reduced-price lunch?*
  • Rows

  • If you answered "yes" to any questions directly above, you are independent of a parent or guardian and only your income will be used to determine WIOA youth eligibility. 

  • Rows
  • Have you or anyone you are living with been ordered to repay cash assistance (OWF), due to determination of fraud and still owe repayment?*
  • Are you currently receiving cash assistance?*
  • Are you currently receiving SNAP?*
  • Rows
  • Do you have a child under age 18 or is 18 who is attending high school full-time?*
  • Are you one of the following (check all that apply):*
  • Have you been given the opportunity to register to vote?*
  • Should be Empty: