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EMPLOYERS’ TRAINING RESOURCEPRELIMINARY APPLICATION Please fill out and submit the application below:
First Name: Last Name: Middle Initial: Permanent Residence: Apartment/Unit #: City: State: ZIP: Mailing Address: Apartment/Unit #: City: State: ZIP: Home Telephone: Alternate Telephone: Cell Phone: Social Security #(Last four digits): Birth Date: Age: Email:
First Name:
Last Name:
Middle Initial:
Permanent Residence:
Apartment/Unit #:
City:
State:
ZIP:
Mailing Address:
Home Telephone:
Alternate Telephone:
Cell Phone:
Social Security #(Last four digits):
Birth Date:
Age:
Email:
Current High School: Current Grade Level: High School Counselor: 1. If not attending school, did you drop out? Yes No If yes, what is the highest grade you completed? 2. Are you behind in school credits? Yes No If yes, how many? 3. Have you passed your Exit Exam (CAHSEE)? Yes No If no, which subject(s) have you not passed? Math ELA 4. What is your current GPA (approximate)? 5. Are you planning to go to college after H.S? Yes No
Current High School:
Current Grade Level:
High School Counselor:
1. If not attending school, did you drop out? Yes No
If yes, what is the highest grade you completed?
2. Are you behind in school credits? Yes No
If yes, how many?
3. Have you passed your Exit Exam (CAHSEE)? Yes No
If no, which subject(s) have you not passed? Math ELA
4. What is your current GPA (approximate)?
5. Are you planning to go to college after H.S? Yes No
6. Do you live with your parents? Yes No If no, with whom do you live? 7. Are you a foster child? Yes No If yes, who is your caseworker? 8. Do you have a disability? (learning, physical, mental) Yes No If yes, please explain. 9. Are you a citizen of the United States? Yes No If no, do you have authorization to work in the U.S.? Yes No 10. Are you a teen parent or pregnant? Yes No 11. Are you on juvenile probation of any sort? Yes No
6. Do you live with your parents? Yes No
If no, with whom do you live?
7. Are you a foster child? Yes No
If yes, who is your caseworker?
8. Do you have a disability? (learning, physical, mental) Yes No
If yes, please explain.
9. Are you a citizen of the United States? Yes No
If no, do you have authorization to work in the U.S.? Yes No
10. Are you a teen parent or pregnant? Yes No
11. Are you on juvenile probation of any sort? Yes No
This only applies to males. Are you registered with the Selective Service? Yes No
This only applies to males.
Are you registered with the Selective Service? Yes No
Must include two different alternate contacts WHO ARE NOT currently living with you. 1. Name: Relationship: Address: City & State: Phone: Cell Phone: 2. Name: Relationship: Address: City & State: Phone: Cell Phone:
Must include two different alternate contacts WHO ARE NOT currently living with you.
1. Name:
Relationship:
Address:
City & State:
Phone:
2. Name:
WRITE A BRIEF STATEMENT ABOUT YOURSELF, INCLUDE WHY YOU WOULD LIKE TO BE PART OF THE YEAR ROUND, CSUB CAREER BEGINNINGS PROGRAM, AND WHAT YOUR FUTURE PLANS ARE
You MUST mail in or fax a copy of your unofficial transcript to the Career Beginnings office.