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@gmail.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Education
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
Your Unique 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 able to attend training 5 hours per day, 3 days a week?
Are you able to pay or raise the funds to pay the $1,500 AIC WORKS™ Program Fee?
⚠️ Attendance Policy Reminder If you miss class more than 3 times, this may result in disqualification from the program and loss of deposit and/or tuition reimbursement.
Will the participant have transportation support available to attend scheduled training classes?
Please write a short statement explaining your commitment to participating in and completing the AIC WORKS™ Program.
The AIC WORKS™ Program is a 10-week training program. A $1,500 program fee is required to participate. ⚠️ Attendance Policy Reminder, If you miss class more than 3 times, this may result in disqualification from the program and loss of deposit and/or tuition reimbursement.
What are your goals for joining the AIC Works™ Training Program?
References:

Please provide contact information for two references (include name, relationship, phone number, email)
Reference # 1:
Reference 1 Full Name:
Reference Relationship to Applicant:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Reference # 1 Email:
example@gmail.com
Reference # 1 Address:

Street Address

Street Address Line 2-Apt#, Lot# or Ste #

CityState

Zip CodeCountry
Reference # 2:
Reference #2 Full Name
Reference Relationship to Applicant:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Reference # 2 Email:
example@gmail.com
Reference # 2 Address:

Street Address

Street Address Line 2 - Apt#, Lot# or Ste #

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
Date

MonthDayYear
Date of Submission
Type a question
Should be Empty: