LLWA TRAINING APPLICATION

If you would like to apply for WIOA funding assistance and live in: Cass, Christian, Logan, Menard or Sangamon Counties, please complete the application below.
* If you worked for an employer which closed or had a significant lay-off in: Cass, Christian, Logan, Menard or Sangamon County, but you live outside of these counties, you may have a choice on which office you utilize for funding purposes. Please call 217.524.5996 for more information.
If you live outside of: Cass, Christian, Logan, Menard or Sangamon Counties, please refer to the link below for other WorkNet Center locations throughout Illinois.

Illinois WorkNet Service Finder
Full Name*

First NameMiddle NameLast Name
Email Address*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
IF YOU RESIDE OUTSIDE OF CASS, CHRISTIAN, LOGAN, MENARD, OR SANGAMON COUNTIES PLEASE COPY AND PASTE THE ADDRESS BELOW TO YOUR ADDRESS BAR TO FIND YOUR WORKNET CENTER.

https://www.illinoisworknet.com/Training/Pages/wioacenters.aspx
County you reside in:*
Phone Number*

Area CodePhone Number
Birthdate*

MonthDayYear
Date
Race (select all that apply)*

Black or African AmericanCaucasian/WhiteNative AmericanAsian or Pacific IslanderOtherTwo or more racesPrefer Not to answer
Hispanic (of any race)*

YesNoPrefer not to disclose
Gender*

MaleFemaleOtherPrefer not to disclose
Preferred Language*
Other preferred language:
TRAINING GOALS
What type of training program are you pursuing? :*
Have you been accepted into this program?*

YESNONEED TO FINISH PRE-REQUISITES FIRST
What school (or employer) will you be attending?*
What Date Will You START your Training Program?*
What Date Will You COMPLETE your Training Program?
What type of credential are you pursuing?*
If obtaining a specific license, what type of license is it? (ie: CDL, LPN, RN, etc)
What grants have you applied for? (Check ALL that apply)*

MAP Grant (Illinois)PELL Grant (Federal)Other Grants or Student LoansNone of the above
Are you able to attend training full time throughout the course of the training?*

YESNO
Identify Job Titles that you will be able to apply for after you complete training. (Be Specific)*
What are your hourly wage expectations after you complete the training?*
Do you have a valid driver's license?*

YESNO
Do you have reliable transportation to attend school?*

YESNO
While attending school, will you need financial assistance with child care expenses?*

YESNO
If the answer to the above question is yes, how many children will need child care services?
Before receiving WIOA childcare assistance, you must apply for assistance through Community Child Care Connections. Have you applied for assistance at COMMUNITY CHILD CARE CONNECTIONS?

YESNOSubmitted application, but eligibility is still pending
How do you plan to support yourself (and family) while attending school?*
PREVIOUS EDUCATION: CLICK ALL THAT APPLY*

HS Graduate or GEDSome College or Trade School but did not completeCollege or Trade School Completion
PLEASE LIST ALL LICENSES OR CERTIFICATES THAT YOU HAVE OR HAVE HAD (ie: LPN, RN, CDL, Medical Assistant, CNA, etc.)*
WHAT IS THE LAST GRADE YOU COMPLETED?*

High School Dropout without Diploma or GEDHS Diploma or GEDTrade School Certificate or LicenseLess than 2 years of collegeAssociate's DegreeBachelor's DegreeMaster's Degree
ELIGIBILITY
Public Assistance/Income (check ALL that apply)

FOOD STAMPS (within past 6 months)TANF or SUPPLEMENTAL SOCIAL SECURITY (SSI)SOCIAL SECURITY DISABILITY (SSDI)UNEMPLOYMENT INSURANCE (within past 3 years)PENSIONLOW-INCOME FAMILYNONE OF THE ABOVE
Employment Status/Details (Check ALL that apply)

Currently NOT employedCurrently employed FULL TIMECurrently employed PART TIMENO PREVIOUS WORK HISTORYIn last 24 months, held or is now holding a temporary, seasonal, or day-to-day employment jobIn last 24 months, employment ended more than onceUnemployed for at least 6 of past 13 weeksUnder-employed, working or needing to work multiple jobs and/or earning less than $15/hourLaid off, fired or left job due to COVIDSelf-employed and now significantly under-employed due to COVID
Barriers (Check ALL that apply)

DISPLACED HOMEMAKER (previously providing unpaid services to family members in the home and who has been dependent on the income of another family member but is no longer supported by that income; or is dependent spouse of member of Armed Forces on active duty, and is unemployed or underemployed and having difficulty obtaining or upgrading employmentIndian, Alaska Native, or Native Hawaiian indiviualOlder individual (age 55 or over)Ex-offenderHomeless individualYouth who has aged out of foster care systemEnglish language learnerSingle parent (including single pregnant women)
Offender Status*

Never been convicted of a misdemeanor or felonyMisdemeanor ConvictionFelony ConvictionHave a felony or misdemeanor conviction pending
Are you a veteran?*

YESNOI am CURRENTLY serving in the military
If you are a Veteran, please list dates of service:
Do you have any of the following disabilities? (select all that apply)*

No DisabilitiesDisabledIndividual with a disability affecting employmentDevelopmental DisabilityLearning DisabilityLEP (Limited English Proficient)OtherPrefer not to disclose
INCLUDING YOURSELF, how many family members live with you?*
EMPLOYMENT HISTORY

Starting with your MOST RECENT job, YOU MUST LIST YOUR THREE MOST RECENT JOBS (if applicable)
Job 1
Employer Name
City, State
Hours per week
Start Date

MonthDayYear
End Date

MonthDayYear
Hourly Wage?
Job Title:
Reason for Leaving
Job 2
Employer Name
City, State
Hours per week
Start Date

MonthDayYear
End Date

MonthDayYear
Hourly Wage
Job Title:
Reason for Leaving
Job 3
Employer Name
City, State
Hours per week
Start Date

MonthDayYear
End Date

MonthDayYear
Hourly Wage?
Job Title:
Reason for Leaving
NOTICE OF CERTIFICATION

By submitting this on-line application, I certify that the preceding information is correct to the best of my knowledge and that there is no intent to commit fraud. I have been advised that this system may be entered into a computerized system and will not be shared with other agencies for the purpose of administering programs of these agencies. I have the right to inspect this information (if entered into the computerized system) and initiate appropriate corrections through the Land of Lincoln Workforce Alliance. I hereby acknowledge that if the information relating to eligibility determination requires verification/documentation, by my submission of this application; I authorize others to release information to the Land of Lincoln Workforce Alliance for eligibility determination criteria.
Thank You for Your Submission. You will receive further instructions by email. (Please be sure to check your Spam folder.)
“The Land of Lincoln Workforce Alliance, an Illinois workNet™ Center, is an Equal Opportunity Employer/Program Provider. Auxiliary aids and services are available upon request to individuals with disabilities.”
Should be Empty:

If you would like to apply for WIOA funding assistance and live in: Cass, Christian, Logan, Menard or Sangamon Counties, please complete the application below.

IF YOU RESIDE OUTSIDE OF CASS, CHRISTIAN, LOGAN, MENARD, OR SANGAMON COUNTIES PLEASE COPY AND PASTE THE ADDRESS BELOW TO YOUR ADDRESS BAR TO FIND YOUR WORKNET CENTER.

TRAINING GOALS

ELIGIBILITY

EMPLOYMENT HISTORY

Job 1

Job 2

Job 3

NOTICE OF CERTIFICATION

Thank You for Your Submission. You will receive further instructions by email. (Please be sure to check your Spam folder.)