YouthBuild Application
Please complete the application and someone will reach out to you soon. For more information about the YouthBuild program, please visit: https://www.vcwwestpiedmont.com/about/youthbuild
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
How did you hear about us?
Highest Educational Level Completed
Last School Attended
Date Last Attended
-
Month
-
Day
Year
No worries if you don't remember the exact date.
List any certifications or degrees you currently hold:
Do you have any Dependent Children?
Yes
No
Do you have access to a computer and the internet?
Yes
No
Are you (or were you previously) in Foster Care?
Yes
No
Upon completion of training, do you intend to seek full-time paid employment in the occupation in which you were trained?
Yes
No
Are you a Veteran?
Yes
No
If "yes", please enter the following:
Are you a Spouse of a Veteran?
Yes
No
If you are unemployed, list the number of weeks unemployed in the past 26 weeks:
Unemployment Insurance Benefits - Check all that apply
Applied
Recieved
Exhausted
Available Work Hours:
Funding is available for all or most of the situations below. Your answers help us see what programs you may be eligible for. All information is confidential and held in the strictest of confidence. Check all of the following that apply to you:
In a low-wage job
Disability
Homeless
Childcare Issues
Transportation Issues
Struggles with Reading/Writing/Math
Struggles with Technology
English is not my primary language
Substance Abuse (alcohol, street drugs, prescription drugs)
Criminal History
If you have a criminal history, please list your charges and pending charges:
Have you worked in the last six months?
Yes
No
If yes, what is the total gross amount earned?
The gross amount is the total amount of something before any deductions or taxes are applied.
Have you ever been fired or forced to resign from a job?
Yes
No
If yes, please explain:
List your employment experience (most recent first)
List family members living in your home and any wage/benefit amount they've recieved in the past six months, starting with your information:
Family Member:
Family Member:
The West Piedmont Workforce Development Board programs provide financial assistance for individuals who want to improve themselves through training and employment. Please tell us a little about yourself, your career goals, and how these programs can help support you in successfully accomplishing your goals. Use this opportunity to provide as much detail about yourself.
All information is confidential and held in the strictest of confidence
I certify that the information provided is true to the best of my knowledge. I am also aware that the information I have provided is subject to review and verification and I may have to provide documents to support this application. I am also aware that I am subject to immediate termination if I am found ineligible after enrollment and may be prosecuted for fraud and/or perjury. I allow release of this information for verification purposes and understand that it will be used to determine eligibility. I further certify that, to the best of my knowledge, no member of my immediate family is employed in any administrative or supportive function in the West Piedmont Workforce Development Board or any agency or supported by the board. As used here, “family” means “two or more persons related by blood, marriage, or decree of court, who are living in a single residence and are: (1) a husband, wife, and dependent children, or (2) a parent or guardian and dependent children, or (3) a husband and wife.”
Parent/Legal Guardian Signature (if under 18)
Submit
Submit
Should be Empty: