YouthBuild Application

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 NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
How did you hear about us?
Highest Educational Level Completed
Last School Attended
Date Last Attended

MonthDayYear
2 digit month, 2 digit day, 4 digit yearNo worries if you don't remember the exact date.
List any certifications or degrees you currently hold:
Do you have any Dependent Children?
Do you have access to a computer and the internet?
Are you (or were you previously) in Foster Care?
Upon completion of training, do you intend to seek full-time paid employment in the occupation in which you were trained?
Are you a Veteran?
If "yes", please enter the following:
Are you a Spouse of a Veteran?
If you are unemployed, list the number of weeks unemployed in the past 26 weeks:
Unemployment Insurance Benefits - Check all that apply
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:
If you have a criminal history, please list your charges and pending charges:
Have you worked in the last six months?
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?
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)
Should be Empty: