Employment and Training Application

Employment and Training Application
Date

MonthDayYear
Date
Referral Source
Referral Party
Contact Information
How did you hear about The HELP Center*
Referral Type
Participant Information
Name*
Address*
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Social Security Number*
or Last 4 Digits
Screening questions
Are you currently interested in education and/or training?
Are you currently interested in obtaining employment?
Do you have any challenged to gainful employment? Yes or No*
Services of Interest
What type of training are you interested in?*

Work Readiness TrainingVocational Training
Acknowledgement
These services will be provided at no cost to you and will be funded by the Supplemental Nutrition Assistance Employment and Training Program, the county, and participating agencies. If you choose to take this opportunity, you may also be provided assistance with transportation, books/supplies, work clothing or uniforms, childcare, and other costs related to participating as funding permits. You may be exempt from participation if there is no funding available to provide these supports. Supportive services may continue for up to 90-days after getting a job if you stay connected to our SNAP Employment and Training provider. Contact is once a month, or more as needed, via text, email, phone, or in person with us and/or our partner agency. Since this is a voluntary program, you are not required to participate to continue receiving Food and Nutrition Services (FNS) benefits. If you would like to be a part of this program, please read and sign this statement: | understand that this is a voluntary program, and it does not affect my FNS benefits. While I understand that this is a voluntary program, I agree to fully participate in order to increase my chances of finding employment or getting a better job.
Terms and conditions

I agree to receive promotional messages sent via an autodialer, and this agreement isn't a condition of any purchase. I also agree to the Terms of Service and Privacy Policy. 3 Msgs/Month. Msg & Data rates may apply.I agree to receive customer support text messages as needed for the services and programs I am enrolling in at the phone numbe rprovided to The HELP Center. Msg & Data rates may apply.
Participant Signature*

Clear
Date

MonthDayYear
Date
Referral Party
Should be Empty:

Employment and Training Application

Participant Information

Screening questions

Services of Interest

Acknowledgement