WPD-010-MQC-CV ROUXBE PRO COOK APPLICATION

WCCC ROUXBE PRO COOK

Learner Application
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
County of Residence
Phone Number*

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
E-mail*
Are you a resident of Maine?*

YesNo
Are you a US citizen?*

YesNo
Ethnic Group*

Not Hispanic/LatinoHispanic/Latino
Race*

American Indian or Alaska NativeAsianBlack or African AmericanWhiteNative Hawaiian or Other Pacific Islander
Gender*

MaleFemaleOther
Education (highest grade completed)*

Less than HS Diploma, GED, or HiSetHS Diploma, GED, or HiSetSome college/no credentialCredential < 2 year or Associate degreeAssociate's degreeBachelor's degreeMaster's degree of higher
Are you currently employed?*

YesNo
Are you currently employed with a Hospitality Maine member company?*

YesNo
If so, what company?*
If so, do you work full-time? *
Do you plan on using this course to enter or remain in the culinary field?

YesNo
How did you hear about this course?*

NewspaperEmail NewsletterFacebookWord of MouthOther
I certify that all information on this application is accurate and complete.
Signature*
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WCCC ROUXBE PRO COOK