Step Up for Women in Construction Pre-Apprenticeship Application

Where did you learn about Step Up for Women? *

If you were referred by a previous graduate, what is their name?

Step Up site closest to you: *

Name *

First

Last

What is your preferred name/nickname?

If you go by a name other than your given name please tell us here

Date of Birth *

What are the last 4 digits of your social security number? *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

What county do you currently live in? *

Example: Kanawha, Lincoln, Putnam, Clay

Phone Number *

Cell Phone

Personal Information

Do you currently have a driver's license? *

Yes
No
Yes, but it's suspended

Do you own a car and is it available for personal use? *

Are you currently married?

Yes currently married
No never married
Separated
Divorced

Do you have dependents? *

Number of people in household? *

Are you willing and able to obtain full time employment at the conclusion of training? *

Yes
No (please explain below)

Do you currently or are you scheduled to receive Unemployment Compensation? *

Current Estimated Yearly Household Income: *

0 - 10000
10000 - 25000
25000 - 50000
50000 +

Are you currently in recovery from substance abuse?

Yes
No
Formerly in recovery
I would like more information about getting help for substance abuse

Have you been vaccinated against Covid 19? *

Do you have a physical or mental disability that requires accommodations that you must consider when looking for a job? *

Have you ever been convicted of a felony? (Your answer will not impact the outcome of your application) *

Have you ever been convicted of a misdemeanor? (Your answer will not impact the outcome of your application) *

Career Goals and Qualifications

Why are you interested in enrolling in the Step Up For Women training program? *

Education

Do you have your High School Diploma or GED? *

Highschool Diploma
GED
No

List all vocational technical courses completed:

Include course title, year completed, and school.

Have you taken any courses since high school?

List all degrees and professional/vocational certificates, year received, and school:

Employment History

Current Employment Status: *

Employed full time
Employed part time
Unemployed
Student

Employment history: Include title and wages for the past five years *

List most recent jobs first.

Any additional information:

Provide any other information that you feel makes you a good candidate to participate in the Step Up for Women training program.

Technology

Do you have reliable access to a computer you can use for class? *

Do you have reliable access to the internet for class? *

Optional (We will use this data for grant reporting. All data will remain anonymous and will only be used for this purpose.)

Please indicate how you identify yourself: The following items are OPTIONAL. No information you provide in this section will be used in a discriminatory manner.

American Indian or Alaska Native (including all Original Peoples of the Americas)
Asian (including Indian subcontinent and Philippines)
Black or African American, not Hispanic (including Africa and the Caribbean)
Native Hawaiian or Other Pacific Islander (Original Peoples)
White, not Hispanic (including Middle Eastern)
Hispanic or Latino
Two or More Races (not Hispanic or Latino)
Other
Prefer not to answer

Check the boxes for any barriers you are currently facing and would like resources to overcome.

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