WORK READY ENID ENROLLMENT FORM

ENROLLMENT FORM
- Full Name
- Date of Birth
  
  MonthDayYear
  Date
- Cell Phone
  
  Area CodePhone Number
- Home Phone
  
  Area CodePhone Number
- Email
  example@example.com
- Best way to contact you?
- If you don't answer, is it okay to leave a voicemail?
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Emergency Contact Name
  
  First NameLast Name
- Emergency Contact Phone #
  
  Area CodePhone Number
- Emergency Contact Relationship
- Do you have internet access?
- Are you interested in remote work?
- How will you get to work or class?
- Do you have a valid ID? (select all that apply)
- To understand how to plan our services and adapt our programs to better fit those we serve, we need to learn more about you.
- What gender do you identify with?
- What pronouns do you use?
  
  Other
- What is your race/ethnicity? (select all that apply)
  
  Other
- What language do you speak most often at home?
  
  Other
- American Citizen
  
  Other
- Martial Status:
  
  Other
- Military Status
  
  Other
- How many children do you have under the age of 18?
- If you have children, please list the years they were born (for example: born in 2020 or born in 2016). If you don’t have any children, write 'None.'
- Are you currently pregnant?
- Do you currently receive any of these safety net services? (Select all that apply) Those who receive any public assistance will be given top priority.
- To help us identify what jobs or training classes would be a good fit for you, we need to get some basic information about your educational and employment history.
- What is the highest level of education that you have completed?
  
  Other
- Are you currently enrolled in school/college
- To help us determine what WRO employment and training resources may be of interest to you, we need to get some information about your employment situation and/or history.
- Are you currently employed?
- How long have you worked at your current job?
- How many hours on average do you work per week?
- What is your hourly wage? ($)
- Does your current employer offer health insurance?
- It's perfectly fine if you're not currently employed. We assist individuals who are unemployed. However, to better support you, we need some information about your employment history. This will help us connect you with the right resources, training, and job opportunities that might be a good fit for you.
- How many hours per week are you interested in working?
- Are you unsure about how many hours you would like to work per week?
- What is the minimum hourly wage you need to maintain your living standards?
- Have you previously had a full- or part-time job?
- When was the last time you had a full- or part-time job?
- How long did you work at your previous job (months/years)?
- On average, how many hours per week did you work at your previous job?
- What was your previous hourly wage?
- Were you offered health insurance at your previous job?
- Were you offered paid time off at your previous job?
- Some people experience challenges that make it hard to find or keep a good job. We work with many partner agencies that may help address these challenges.
- Which of the following best describes your current housing?
  
  Other
- Are you currently taking medication that would affect your ability to work?
- Do you have any disabilities or health conditions that might affect your ability to work?
- Will you need accommodations to participate in the workshop or when working?
  
  Other
- Can you lift 25 lbs?
- Are you currently involved in the criminal justice system?
  
  Other
- Have you ever been convicted of a felony?
  
  Other
- Have you ever been convicted of a misdemeanor?
  
  Other
- Are you currently on probation or parole?
- Are you interested in applying for any of the services listed below? These services may be available to people who are unemployed or whose income isn’t enough to cover their bills. Some of these services may not be available where you live. (Check all that apply)
- Many people hear about WRO through other people, agencies or advertisements on billboards or buses. We are curious how you found out about WRO, so we can make sure more people know about us.
- How did you hear about WRO? (Select all that apply)
- What motivated you to come in to WRO today?
- I authorize [yes/no] Work Ready Oklahoma to use my image, likeness, and/or voice in any media for promotional or informational purposes. I waive the right to inspect or approve the final product.
- I consent to Work Ready Oklahoma collecting and using my information for the purposes of helping me find employment. I would like to receive Email and SMS communications from WRO. I am aware that WRO will NOT share my personal information.
- Signature
- Date
  
  MonthDayYear
  Date
- Should be Empty: