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.Format: (000) 000-0000.
Date of Birth*

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

Atlanta Guest Experience AcademyCulinaryCyber SecurityForklift TrainingNAPA Automotive TechnicianSecurity GuardSolar School InstallationWeldingGEDBrandywine Cares (Job Search - Support and Coaching)EmployEd series (one-week digital literacy class)
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
Middle Eastern or North African
US Citizen*

YesNo
Highest Level of Education*

Some high school but did not graduateGED certificateHigh School diplomaSome college (no degree)Bachelors 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
Are you currently employed?

YesNo
Current Employer*
Current Hourly Wage*
Average Hours Worked Per Week*
Should be Empty:

Job Training Application Questionnaire: