Participant Application – Christian Women's Job Corps of Gregg County

Name

Email

Address

City

State

Zip Code

Phone number where you can be reached

Birth Date

Email

Are you?

Married

Seperated/Divorced

Single

Widowed

Emergency Contact: Name/ Phone / Relationship *

Who lives in the same house as you? If you live in a shelter then please just put "Shelter" in the space below.

Name | Age | Relationship *

Name | Age | Relationship

What Grade did you complete

(We do not require a high school diploma for our program)

When (what year?)

Where have you worked? (Please begin with the latest)

Employer | Your Job | Date Ended

What is your source of income?

A drug test is not required for entrance to our program, but we do reserve the right to do a random drug test during the semester. Would you be willing to submit to a drug test? *

Yes

No

Of all your jobs, which one did you like best? Why?

What do you enjoy doing? (For example: cooking, artwork, crafts, cleaning, mechanics or anything else)

How did you learn about the Christian Women’s Job Corps?

Do you have any computer skills in the following areas? (If you don't have any computer skills then that is totally fine because we will teach you!)

Do you have someone you can confide in?

Yes

No

Are there any circumstances in your life that may create problems for you while participating in the CWJC?

How do you think Christian Women’s Job Corps can help you?

Please give 3 references we may contact:

Name | Phone Number

Comments

The Christian Women's Job Corps welcomes ladies with criminal records to join our program. However, we still conduct background checks on all of our students and volunteers to provide us with needed insight for the management of our program. Are you willing to submit to a background check? *

Yes

No

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