Delaware Skills Center Admissions Application

Admissions Application
Course of Interest*
Gender*

MaleFemale
Applicant Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone Number:*

Area CodePhone Number
Home Phone Number:*

Area CodePhone Number
E-mail*
Are you a United States citizen?*

YesNo
Are you registered for Selective Service? (Males Only)*

YesNo
If not, click on the following link to register: https://www.sss.gov/Registration/Register-Now/Registration-Form
Personal Information
Is English your second language?*

YesNo
Preferred Language:*
Do you have a valid State of Delaware driver's license?*

YesNo
If not, do you have a valid driver's license issued from another state?

YesNo
What state is your driver's license issued from?
Is your license subject to revocation or suspension within the next 4 months?*

YesNo
Do you have your own vehicle for transportation?*

YesNo
Veteran Status
Veteran:*

YesNo
Education
Are you a High School Graduate?*

YesNo
Highest Grade Completed*
What is the name of the High School or GED program attended?*
Graduation Date*

MonthDayYear
Date
Name of Post-Secondary Institution and Major
Please add dates of enrollment
Have you attended other training programs in the last 5 years?*

YesNo
If Yes, list the school and course name.
Have you ever attended a training programs at the Delaware Skills Center?*

YesNo
If Yes, list course name:
Physical Data
General Health (check one):

ExcellentGoodFairPoor
Do you have any physical limitations that would prevent you from completing this training program?*

YesNo
If you selected yes please explain:
Do you have a full record of your up-to-date immunization records?*

YesNo
Can you lift over 40 pounds?*

YesNo
Background*

Does not exclude you from program.
Have you ever been convicted of a criminal offense?*

YesNo
If yes, give date and brief explanation:
Have you ever been on probation?*

YesNo
Are you currently on probation?*

YesNo
If Yes, who is your Probation/Parole Officer and what is their phone number?
Do you have any court appearances within the next 4 months?*

YesNo
If yes, give date(s) and explain:
Work Experience (if applicable)
Are you currently employed?*

YesNo
Name of Employer:*
Job Title:*
What is your Salary or Hourly Wage? *
Start Date (of current job):*

MonthDayYear
End Date:

MonthDayYear
Employer’s Name and Phone Number:*
Job Duties & Responsibilities:
Are you presently collecting workers’ compensation or disability pay?*

YesNo
Are you presently collecting unemployment?

YesNo
Upload Resume (Optional)

Upload a File

Cancelof
Professional or Personal References
Reference Person 1

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Reference Person 2

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
_________________________________________________________________
Do you have a vacation scheduled that would interfere with your attendance?*

YesNo
Is there anything that would prevent you from accepting full time permanent employment upon completion of this course and maintaining your employment for a minimum of 90 days?*

YesNo
If yes please explain in detail
How did you learn about the Delaware Skills Center?*
Name of Referrer:

First NameLast Name
The ultimate goal and mission of the Delaware Skills Center is full-time employment upon completion of training. I understand that in order to become gainfully employed, I must be free of illegal chemical substances and willing to submit to "drug screening" by perspective employers prior to being hired. If I am found to be using or abusing illegal chemical substances, I will be unable to participate in "placement activities" and therefore not eligible for enrollment at The Delaware Skills Center
All of the information I have provided is true to the best of my knowledge and I fully understand that I will be immediately disqualified from training if the information is false or misrepresented.*

YesNo
Applicants Full Name*
Date

MonthDayYear
Thank you for your interest in the Licensed Practical Nursing (LPN) course.

Applications are now CLOSED for the August 2026 class. On July 1, 2026, the applications will open for the next available class.

Jan 2026
Should be Empty:

Admissions Application

Personal Information

Veteran Status

Education

Physical Data

Background*

Work Experience (if applicable)

Professional or Personal References