Job Training Application Questionnaire

Job Training Application Questionnaire:

City of Refuge 1300 Joseph E Boone Blvd. Data collected in this form is covered by our privacy policy: https://www.cityofrefugeatl.org/privacy
Email*
example@example.com
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Age
Home Address*
Apartment/Unit #
Street Address
City
State
Zip Code
County of Residence*
Program of Interest*

Digital Connections Academy (Computer Basics, Resume Update, Securing Your Network, Online Apps, Intro to Cloud, LinkedIn)EmployED series (one-week digital literacy class)Forklift TrainingGEDCulinaryLogisticsNAPA Automotive TechnicianBrandyWine Cares Career CoachingCyber SecurityWeldingSolar School InstallationPharmacy TechnicianMedical AssistantOther
Other Program of Interest*
EmployED Session*
What is your race?
What is Your Ethnicity?*

Hispanic or LatinoNon-Hispanic or Latino
Race

Please choose all that apply
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
US Citizen*

YesNo
Highest Level of Education*

GED or DiplomaSome High SchoolSome CollegeCollege Degree
Have You Served in the US Military?*

YesNo
Are You Disabled?*

YesNoMaybe
Do You Receive Public Benefits?*

YesNo
Have You Been Convicted of a Felony?*

YesNo
Gender*

MaleFemalePrefer not to say
Current Employer*
Current Hourly Wage*
Average Hours Worked Per Week*
Should be Empty:

Job Training Application Questionnaire: