AIC WORKS™ Program Inquiry Form

AIC WORKS™ Program Inquiry Form
Personal Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Education*

High School GraduateGEDCollege GraduateDid not Graduate
Employment History(Last 5 years)

Please list your most recent employer first, followed by any previous employers from the past five years, in order from most recent to oldest.
If this is your first job, select "No Previous History" and continue to the next question, skipping this section.
No Employment History
No Employment History Skip to the next section
Current/ Last Employer
Company Name
Exit Date:*

MonthDayYear
Your Last Day
Start Date*

MonthDayYear
Start Date
Job Title
Responsibilities
Employer 2:
Company Name
Exit Date:*

MonthDayYear
Your Last Day
Start Date*

MonthDayYear
Start Date
Job Title
Responsibilities
Employer 3:
Start Date:

MonthDayYear
Date
Exit Date:*

MonthDayYear
Your Last Day
Job Title
Job Responsibilities:
Describe your job responsibilities
Responsibilities
Employer 4:
Exit Date:

MonthDayYear
Your Last Day
Start Date:

MonthDayYear
Start Date
Job Title:
Job Responsibilities:
Describe your job responsibilities
Employer 5:
Exit Date:

MonthDayYear
Your Last Day
Start Date:

MonthDayYear
Start Date
Job Title:
Job Responsibilities:
Describe your job responsibilities
Skills and Qualifications
Certifications/Licenses
Please put N/A if you do not have any Certificates or special Licenses
Skills
It is time to Brag about yourself: List your skills as they relate to this new job, such as Good Listener, Effective Communicator, Problem Solver, Team player.
Are you available Monday, Tuesday and Thursday from 8 am – 3 pm?*

YesNo
Why are you interested in this employment program?*
What are your Personal goals?*
References:

Please provide contact information for two references (include name, relationship, phone number, email)
Reference # 1:*
Reference 1 Full Name:
Phone Number:
Please enter a valid phone number.
Reference # 1 Email:*
example@gmail.com
Reference # 1 Address:

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Reference # 2:*
Reference #2 Full Name
Phone Number:
Please enter a valid phone number.
Reference # 2 Email:*
example@gmail.com
Reference # 2 Address:

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Upload Resume/CV*

Cancelof
CONSENT

I consent to the processing of my personal data for the purpose of Employment with the AIC Works™ program.
Signature*

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Date*

MonthDayYear
Date of Submission
Should be Empty: