• Application for Eligibility/Initial Assessment

    SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM (SCSEP)
     

    Please have these documents ready before you begin

    1. Your valid Driver’s License or State ID Card
    2. Proof of Address, if different from what is on your Driver's License or State ID Card.
    3. Your signed Social Security Card
    4. DD-214 for Veterans (if applicable)
    5. Proof of income for all household members for the last 6 months. For example:
      • Social Security benefit letters
      • Pay stubs
      • Unemployment Compensation Statements or printout
      • Public Assistance or Welfare Payments printout
      • Veteran Payments Statement from VA
      • Pension or retirement income statements

    Questions?

    Call Vantage at 330-253-4597 Option 3, Monday–Friday, 8am–4pm Eastern time.

  • Before you begin, please read these helpful tips to make your application smooth and successful:

    Ohio Residents Only: This application is only for Ohio residents living in our serviced area. [Click here to check our county list].

    ⚠️ Important Note: Use the Back, Save, and Next buttons at the bottom of the page. Do not use your browser’s back arrow at the top of the screen, or you may lose what you typed.

    Saving Progress: To save and finish later, click Save. You’ll be asked to make a free account with your email and a password so you can come back to it.

  • Image field 410

  • If something does not apply please write "N/A". Application is good for 60 days from application date. After 60 days a new application must be submitted.

  • Gender
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Today
     - -
    2 digit month, 2 digit day, 4 digit year

  • STOP!

    You must be 55 years or older to qualify for Senior Community Services Employment Program.

    Please contact us at 330-253-4597 Option 3 for further questions.

  • Looking up your city and county… If nothing appears in a few seconds, check the box below to enter it yourself.

  • STOP!

    Your region in not served. If you thinks it's an error please contact us at 330-253-4597 Option 3.

  • Zip Code (Conditional Logic Autofill's City, State, County)
  • Is Your Mailing Address same as Residence Address?
  • Format: (000) 000-0000.

  • Number in Family

    Please list all members of your household (print whole name, relationship, and age of each person), beginning with Applicant: [relationship means self, spouse, son, granddaughter, etc.] Do not list roommates or significant others if not married.
  • Family Members
    Rows
  • Are you a former SCSEP Participant?
  • How did you hear about us (check one)?
  • Do you engage in any volunteer work at this time?
  • 0/200
  • Employed at the time of application?
  • Receiving public assistance? (Check as many as apply for APPLICANT only)
  • Race: (Check as many as apply)
  • Are you a U.S. Citizen?
  • Veteran? Or Eligible Spouse of a Veteran? If yes, bring a copy of your or your spouse’s DD-214 (Check all that apply)

  • *Eligible Spouse: The spouse of any of the following individuals:

    • Any veteran who died of a service connected disability.
    • Any veteran who has a total disability resulting from a service-connected disabikity.
    • Any Veteran who died while a disability so evaluated was in existence.
    • Any member of the Armed Forces serving on active duty, who at the time of application has been listed by the Secretary for more than 90 days as missing in action, captured in the line of duty by a hostile force, or forcibly detained or interned in a line of duty by a foreign.

  • EDUCATIONAL INFORMATION

  • Check the education level you have achieved
  • Check all the degrees that you have received.
  • 0/20

  • EMPLOYMENT/TRAINING INFORMATION

  • Do you have a valid Driver's License?
  • How will you get to work?
  • Do you need benefits?
  • What are you willing to work? (Check all that apply)
  • Are you looking for?
  • Have you registered at OhioMeansJobs?
  • Are you working with any other agencies to help you get a job?
  • If yes, which Agencies? (check all that apply)
  • Do you have highspeed internet that you could connect an internet capable device?
  • Do you have a computer, tablet or other device able to connect to high speed internet?
  • What are the top 3 things you value most in a job? (Check only 3.)
  • What are your top 3 job interests? (Check only 3.)
  • 0/40
  • Skills Assessment: If you currently have a skill, mark the 1st column under HAVE.  If you’re interested in learning the skill mark the 2nd column under WANT.
    Rows

  • BARRIERS TO EMPLOYMENT

  • What may prevent you from getting a job? (Check all that apply.)
  • Are you at risk of homelessness? Check all that apply to you at the time of this application:
  • Are you currently homeless?
  • Do you have a Disability? (check all that apply)
  • Would assistance with any of the following items help you find or maintain employment?
  • Have you ever been convicted of a misdemeanor?
  • Have you ever been convicted of a felony?
  • Have you been incarcerated and released from prison or jail at any point within the last 5 year?
  • 0/20
  • Have you been under post-release supervision at any point within the last 5 years?
  • 0/20

  • WORK HISTORY:

  • Please be sure to fill out this section in detail, listing the most recent employer first. Jobs in the past year must show month/day/year, for example, 1/17/2026. No matter how long ago, the last 3 jobs must be completed, even if you have a resume.

  • From Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • To Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • 0/100
  • From Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • To Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • 0/100
  • From Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • To Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • 0/100

  • HOUSEHOLD INCOME

  • Please enter the monthly gross amount for each type of income for self, spouse, and dependents for the past six (6) months:

  • INCLUDABLE INCOME
    Rows
  • EXCLUDABLE INCOME
    Rows

  • If no income is received, please complete the following:

  • On this date, I certify that my “household income” (the combined income of my current family members, including myself, my husband, wife, and/or dependent children or grandchildren, if applicable) was zero for the past:

  • Applicant Declaration and Authorization:

    I certify that the information and household income provided on this form are true and accurate to the best of my knowledge. I understand that this information will be used by Vantage to determine my eligibility, assess
    my suitability, and build an Individual Employment Plan for the Senior Community Service Employment Program (SCSEP).


    I acknowledge that any personal identifying information collected will be used solely for SCSEP grant purposes, and I release its use for these purposes.


    Finally, I understand that completing this form does not guarantee enrollment, that I am responsible for seeking unsubsidized employment if enrolled, and that intentionally providing inaccurate information may result in termination from the program and legal penalties.

  • Find Current Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date Signed
     - -
    2 digit month, 2 digit day, 4 digit year

  • Upload Needed Documents Below

  • In order for an application to be complete, the following documents are needed:

    1. Your valid Driver’s License or State ID Card
    2. Proof of Address if different from what is on your Driver's license or State ID Card.
    3. Your signed Social Security Card
    4. DD-214 for Veterans (if applicable)
    5. Proof of income for all household members for the last (6) months, for example:
      • Social Security benefit letters
      • Pay stubs
      • Unemployment Compensation-Statements or printout
      • Public Assistance or Welfare Payments- printout
      • Veteran Payments-Statement from VA
      • Pension or retirement income statements

    If you have any questions, please call Vantage at 330-253-4597.

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