Fillable Job Corps Application (College of Eastern Idaho)

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Job Corps Application (College of Eastern Idaho)

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To apply for the Nampa/CWI
Location:
Call: (208) 442-4500
Email documents to:
jobcorps@labor.idaho.gov
Hand Deliver/Mail to:
Idaho Job Corps
3201 Ridgecrest Dr.
Nampa, ID 83687
To apply for the Idaho Falls/CEI
Location:
Call: (208) 535-5389
Email documents to:
jobcorps@cei.edu
Hand Deliver/Mail to:
College of Eastern Idaho
1600 S. 25th E.
Idaho Falls, ID 83404
To apply for the Twin Falls/CSI
Location:
Call: (208) 732-6585
Email documents to:
stephengarcia@csi.edu
Hand Deliver/Mail to:
College of Southern Idaho
315 Falls Avenue
Meyer Hoffer Bldg., # 215
Twin Falls, ID 83303
DOCUMENTS NEEDED TO COMPLETE APPLICATION
□ Birth Certificate or U.S. Passport (for self and children if applicable)
□ Social Security Card (signed, for self and children if applicable)
□ Photo Identification (Driver’s License, State ID, other Government issued ID)
□ School Transcripts, High School Diploma or GED & Test Scores
□ If enrolled in school, a letter from school official stating Job Corps is a better
option for you
□ Two letters of reference from non-personal sources (school, work, counselor,
etc.)
□ Immunization Records
□ Medical and Mental Health Records from last two (2) years (only if applying for
residential in Nampa)
□ Proof of Public Assistance (Grant letter, Unemployment Benefit statement,
Food Assistance Letter, etc.) if applicable
□ Income Verification if not receiving Public Assistance (two paycheck stubs, W2)
□ Selective Service registration consent confirmation (18+ male applicants only)
□ Health Insurance card (front and back of card)
□ I-94 or I-551 or I-151 Employment Authorization (if applicable)
□ DD214 (if prior military service)
□ Completed forms in this packet
Once you have gathered all of your required documentation, deliver them to the
center you wish to apply with. Your documents will be reviewed and an
admissions representative will contact you to schedule your intake appointment.
Appointments cannot be scheduled until all required documents have been
submitted and reviewed for eligibility.
Applicants late for their interview may be rescheduled.
Today’s Date _________________ INITIAL INFORMATION FORM
First and Middle Name:
SSN:
Birth Date:
Age:
Street Address:
City, State, ZIP:
Phone #:
Cell phone #:
Email:
Race:
Sex: Male □ Female □
Marital Status:
City/State of Birth:
US Citizen:
Yes □ No □
Country of Birth:
Alien Registration #:
(if not a citizen)
Last School Attended:
HS Diploma □ or GED □
Highest Grade Completed:
Months Out of School
Reason for Leaving School:
No. in
Household:
Receiving Public Assistance:
Yes □ No □ Type:
Family Annual Income:
Individual Annual Income:
Unemployed:
Yes □ No □
If Yes, how many
weeks:
Most recent Employer:
Address
City/State/ZIP:
Position/Title:
Supervisor:
Hours Worked
Per Week:
Wage per Hour:
Starting Date:
Ending Date:
What kind of job duties did you perform?
What did you enjoy about this job?
Why did you or do you plan to leave this job?
Have you ever been in Job Corps?
Yes □ No □ If yes, where & when?
How did you hear about Job Corps?
Have you ever been in the military? Yes □ No □ If yes, when were you discharged?
Do you have a valid driver’s license? Yes □ No □ If no, which applies? Revoked □ Suspended □ Never Issued □
License State and Number:
Expiration Date:
Do you have any children? Yes □ No □ If yes, please answer the following:
Child’s Name(s)
Birth Date(s):
Caretaker’s Name:
Address:
Phone #:
Awards/Hobbies
Have you received and awards or achievements? Please list:
Do you have any hobbies: Please list:
Do you have any additional skills? Please list:
Preferred Pronouns:
Expectations
At Idaho Job Corps, our mission is to “Inspire and Empower Students Towards a Purposeful Life”. Research shows that
empowered individuals take the time necessary to build their physical body as well as their academic knowledge, while
meeting mental health needs and being of service to others. To support this in our students, Idaho Job Corps has several
weekly expectations. These weekly expectations include:
● Fitness: 2.5 hours
● Service Learning: 3 hours
● Life Skills: At minimum, 1 class per week
● Academic Progress
o Maintaining a C or better in all coursework or completion of assigned work
o No missing work/assignments
● Case Management Meeting: 1 weekly meeting
● House Meeting: 1 weekly meeting
● Total Weekly Requirement: 35 hours
o Along with the expectations above, this includes:
▪ Academic tutoring and/or studying
▪ Work experience
▪ Job shadowing
▪ Job Corps related appointments
▪ Employment
▪ Etc.
If a student does not meet the weekly expectations, he/she will, first, be given a warning. The next time the student
does not meet the weekly expectations, he/she will develop an action plan with a staff member. Each subsequent week
where the expectations are not met will result in a minor infraction. After five infractions, a student may be separated
from the Idaho Job Corps program.
Your signature below indicates you have read and understand Idaho Job Corps’ expectations and the consequences if
the expectations are not met.
As an applicant to the Idaho Job Corps, I understand the program expectations. I understand that if I do not meet the
Idaho Job Corps expectations, I will not earn my full weekly stipend, and it can lead to separation from the program.
Student Name: ________________________________________________________
Student Signature: _____________________________________________________ Date: ________________________
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Job Corps Application
Statement of Support
Applicant Name: _____________________
Interview Date: ______________________
To Whom It May Concern:
I do not have any earned income. I am being supported by (supporter’s name) ___________________
who provides me with room and board. I am I am not claimed as a dependent by this person
for tax purposes. (Supporter’s name) _________________________ is not charging me for room and
board.
Applicant signature: ____________________________________ Date: ___________________
Supporter’s signature: __________________________________ Date: ___________________
Supporter’s address: _______________________________________________________________
Supporter’s phone number(s): __
______________________________________________________
Admissions Counselor’s signature: ________________________ Date: ___________________
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Alternate Contact Record
APPLICANT INFORMATION
Your Name:
Your Phone:
A minimum of three (3) alternate contacts are required
Name of parent/guardian:
Address:
City/State/ZIP:
Home Phone Number:
Cell Phone Number:
Work Phone Number:
Email address:
Name:
Relationship:
Address:
City/State/ZIP
Home Phone Number:
Cell Phone Number:
Work Phone Number:
Email address:
Name:
Relationship:
Address:
City/State/ZIP
Home Phone Number:
Cell Phone Number:
Work Phone Number:
Email address:
Name:
Relationship:
Address:
City/State/ZIP:
Home Phone Number:
Cell Phone Number:
Work Phone Number:
Email address:
Name:
Relationship:
Address:
City/State/ZIP:
Home Phone Number:
Cell Phone Number:
Work Phone Number:
Email address:
Schedule Conflicts
Applicant Name:
The Idaho Job Corps is a 35 to 40-hour per week program.
Unless otherwise stated, your hours will be completed at the Idaho Job Corps Center, or at a
community college campus. If you have a job, are already enrolled in school, or have other
schedule conflicts please list your schedule here:
Day:
Monday AM
Tuesday AM
Wednesday AM
Activity:
Schedule:
Day:
Monday PM
Tuesday PM
Wednesday PM
Activity:
Schedule:
Day:
Thursday AM
Friday AM
Weekend AM
Activity:
Schedule:
Day:
Thursday PM
Friday PM
Weekend PM
Activity:
Schedule:
In many cases, your work hours can count towards your Job Corps required hours, but all students will be
required to spend time each week on-center to meet other program required activities.
The current Job Corps program schedule is Monday – Friday, 8:00 am to 4:30 pm.
I have no current schedule conflicts □
Clothing Questionnaire
Applicant Name:
In order to prepare you for a professional working environment, Idaho Job Corps requires that all students
dress in attire appropriate to the student’s work or schooling environment.
Idaho Job Corps training dress code is as follows:
Acceptable
• T-shirts/sweatshirts/hoodies/buton-ups/polo shirts can be worn if clean and appropriate
• Women may wear sleeveless collared shirts or blouses if the width of the fabric from the
neck to the shoulder is three or more inches, otherwise a sweater, cardigan, or jacket must be
worn over the shirt
• Clothing must fit appropriately
• Pants must be worn at the waist.
• Skirts/shorts must fall an inch below the wearer’s fingertips
Not Acceptable
• No tank tops or sweat pants unless used for working out
• No flip flops
• Women’s tops may not expose cleavage or midriff
• Jeans/pants may not have rips, holes, or embellishments
Personal appearance and professional attire are a critical element for success in the workplace. To
this end, students of Idaho Job Corps are required to dress in professional attire every Monday.
Professional attire includes, at a minimum, a solid-colored polo or button-up shirt, with solid-
colored pants. Students can also choose to wear business or professional attire.
We also require students to have at least one set of clothing suitable for exercising in, including
athletic shoes. Exercise clothes should not be revealing, and we ask that both men and women wear
a shirt at all times. Tank tops are permissible for exercising, providing they ensure proper coverage.
Note: any student wearing clothing deemed not to fit the dress code will be asked to change.
Do you have work-appropriate clothing?
□ Yes □ No
Do you have work-appropriate shoes?
□ Yes □ No
Do you have clothing suitable for exercising?
□ Yes □ No
Do you have athletic shoes?
□ Yes □ No
Do you need assistance in getting any of the required clothing items? □ Yes □ No
What size clothing do you wear?
Tops:
Pants:
Shoes:
APPLICANT STATEMENT OF PRIOR CRIMINAL ACTIVITY
Idaho Job Corps Workforce Consultants reserve the right to conduct a background check, including a criminal history, of
all applicants. I understand that my Workforce Consultant will be checking with law enforcement agencies about my
probation/parole status, court records (including unpaid fines), and with other government agencies to determine if I am
being truthful.
Directions
Please completed the following information regarding your criminal history. Should you be unclear of any question or part
of the form, or need assistance, as the Workforce Consultant. Having a criminal history or record does not automatically
disqualify any applicant from participating in the Idaho Job Corps Program.
_______________________________________________ _______________________
Name of Applicant Date of Birth
Section 1:
To be completed by all applicants.
List all city and states you have lived in for the past three years:
City
State
County
Section 2:
Have you ever been adjudicated/convicted of a criminal offense? Yes No
If yes, please complete section three (3) and four (4) on the next page.
If no, please go to section four (4) on the next page.
Section 3:
If you have been convicted, please complete the following chart for ALL convictions.
Charges & Date
Location
City & State
Court Decision
(Guilty, not
guilty, dismissed)
Amount of Time
Served
Amount of Fines
Owed
Pending Court
Dates
(yes/no)
Name of Probation/Parole Officer ______________________________________
Phone Number: _________________________________
Are you still supervised by this Probation/Parole Officer: □ Yes □ No
If no, when were you released from probation/parole? __________________________________________________
Section 4:
I understand that if I knowingly make a false statement regarding my personal history or do not disclose the information
to the Idaho Job Corps Workforce Consultant, it could result in my not being accepted into the Job Corps Program. This
also includes information other that that disclosed on this form, should such information later become available;
separation from the Idaho Job Corps Program is a possible outcome.
__________________________________________________ _______________________
Signature of Applicant Date
__________________________________________________ _______________________
Signature of Parent/Guardian Date
__________________________________________________ _______________________
Signature of Workforce Consultant Date
EXPLANATION OF CRIMINAL CHARGES
Job Corps conducts a criminal history background check on all applicants to determine program eligibility. Please
answer the questions below to help Job Corps assess your ability to successfully complete the program. Use one
form for each conviction.
Applicant Name:
Please thoroughly answer the questions below regarding your conviction
What offence were you convicted of?
When did this offense occur?
Where did this offence occur?
Who was involved with you?
Explain what happened:
What did you learn from this experience?
Applicant signature: Date:
EQUAL OPPORTUNITY IS THE LAW
It is against the law for this recipient of federal financial assistance to discriminate on the following basis:
• Against any individual in the United States, on the basis of race, color, religion, sex, national origin, age,
disability, political affiliation or belied, and
• Against any beneficiary of programs financially assisted under Title 1 of the Workforce Innovation and
Opportunity Act (WIOA) of 2014 on the basis of the beneficiary’s citizenship/status as a lawfully admitted
immigrant authorized to work in the United States, or his or her participation in any WIOA Title 1 – financially
assisted program or activity.
The recipient must not discriminate in any of the following areas:
• Deciding who will be admitted, or have access, to any WIOA Title 1 – financially assisted program or activity;
• Providing opportunities in, or treating any person with regard to, such a program or activity; or
• Making employment decisions in the administration of, or in connection with, such a program or activity.
WHAT TO DO IF YOU BELIEVE YOU HAVE EXPERIENCED DISCRIMINATION
If you think you have been subjected to discrimination under a WIOA Title 1 – financially assisted program or activity,
you may file a complaint within 180 days from the date of the alleged violation with either:
• The recipient’s Equal Opportunity Officer; or
• By postal mail:
Director, Civil Rights Center
ATTENTION: Office of External Enforcement
U.S. Department of Labor
200 Constitution Ave NW
Room N-4123
Washington, DC 20210
• Faxed to (202) 693-6505, ATTENTION: Office of External Enforcement (limit of 15 pages)
• Emailed to CRCExternalComplaints@dol.gov
If you file your complaint with the recipient, you must wait either until the recipient issues a written Notice of Final
Action, or until 90 days have passed (whichever is sooner), before filing with the CRC (see address above).
If the recipient does not give you a written Notice of Final Action within 90 days of the day on which you filed your
complaint, you do not have to wait for the recipient to issue that Notice before filing a complaint with CRC. However,
you must file your CRC complaint within 30 days of the 90-day deadline (in other words, within 120 days after the day on
which you filed your complaint with the recipient).
If the recipient does give you a written Notice of Final Action on your complaint, but you are dissatisfied with the
decision or resolution, you may file a complaint with CRC. You must file your CRC complaint within 30 days of the date
on which you received the Notice of Final Action.
You can get more information at: https://www.labor.idaho.gov/dnn/Job-Seekers/Complaints or
https://www.dol.gov/agencies/oasam/civil-rights-center/how-to-file-complaint
Student Signature Date
Please place a copy of the signed form in the student’s file.
Job Corps Outreach and Admissions
Guide to
The Holland Career Interest Assessment
For young adults, one of the most annoying questions is “what do you want to do for a living?”
Some people have a “calling” to their chosen profession. They knew exactly what they wanted
to do since the second grade. For the rest of us, it’s not that easy. How are you supposed to
know what occupation you want to pursue? A career test can help you discover who you are
and what you want out of your career.
Don’t panic! Idaho Job Corps uses the Holland Career Interest Assessment. This “test” is
actually fun to take! There are no grades, and you don’t pass or fail. There are no right or
wrong answers, so go with what you feel is the best answer. This test will give you ideas about
what you possibly could do for a career, based off your interests, rather than what you just
think you want to do.
On the following page, please fill in the circle for each activity you like, or would like to do. For
example, do you like solving puzzles? Playing games like sudoku and Scrabble? Then you would
fill in the circle to the right of that activity. If you don’t like an activity, just leave the circle
blank. Repeat that for every activity on the page. When you’re done, count the number of
filled circles in each column (“R” “I” “A” “S” “E” and “C”), and write the total in the bottom on
the column.
Once you have your totals, transfer them to the second page. The higher your total in a
category, the stronger your interest is in that grouping. The more interest you have in a
category, the more enjoyment and satisfaction you will have with your work.
• R = Realistic
• I = Investigative
• A = Artistic
• S = Social
• E = Enterprising
• C = Conventional
Finally, research and compare your interests to Job Corps’ career technical clusters. Work
environments fall into similar categories, as well. Therefore, when you determine which
categories you have the strongest interest in, your Workforce Consultant can help you identify
which Job Corps training fit you best.
Career Assessment
(Read each statement below. If you agree, check the box)
I like or would like to:
Solving puzzles
○
Working on cars
○
To work independently
○
To work in teams
○
Organizing things
○
To set goals for myself
○
Building and repairing things
○
Art and music
○
Having clear instructions to follow
○
To influence or persuade people
○
Doing experiments
○
To teach or train people
○
Helping people solve their problems
○
To take care of animals
○
Having my day structured
○
Selling things
○
To do creative writing
○
Working on science projects
○
Taking on new responsibilities
○
To heal people
○
To figure out how things work
○
Putting things together
○
To be creative
○
To pay attention to detail
○
Filing or typing
○
Learning about other cultures
○
Analyzing problems, situations, or friends
○
Playing instruments or singing
○
To think about starting a business
○
To cook
○
Acting in plays
○
Thinking things through before deciding
○
Working with numbers and charts
○
Discussing politics and current events
○
Keeping records of my work
○
Being a leader
○
Working outdoors
○
Working in an office
○
Work with math problems
○
Helping people
○
Drawing
○
Giving speeches
○
R
I
A
S
E
C
TOTALS
Worksheet Tasks
Step 1: Use the profiler to learn about work relates interests and occupations in your area of
interest. Enter your scores from the profiler and circle the three highest scores.
Realistic
Investigative
Artistic
Social
Enterprising
Conventional
Step 2: Explore and compare your interests to Job Corps career technical training clusters.
SOCIAL people are HELPERS. They like to work directly with people rather than things. They
enjoy training, instructing, counseling or curing others. They are often good public speakers
with helpful, empathetic personalities.
ENTERPRISING people are PERSUADERS. They like to work with other people; they particularly
enjoy influencing, persuading and performing. They like to lead and tend to be assertive and
enthusiastic.
CONVENTIONAL people are ORGANIZERS. They are very detail oriented and like to work with
data. They have good organizational and numerical abilities and are good at following
instructions. Conventional people also like working in structured situations.
REALISTIC people are DOERS. They are often good at mechanical or athletic jobs. They like to
work with things like machines, tools or plants and they like to work with their hands. They are
often practical and good at solving problems.
INVESTIGATIVE people are THINKERS. They like to watch, learn, analyze and solve problems.
They often like to work independently, tend to be good at math and science and enjoy
analyzing data.
ARTISTIC people are CREATORS. They like to work in unstructured situations where they can
use their creativity and come up with new ideas. They enjoy performing (theater or music) and
visual arts.
Step 3: List your top 3 scores, to create your Interest Profile:
Idaho Department of Labor
Job Corps Privacy Act Statement
This statement applies to forms used by the Idaho Department of Labor for the Job Corps program that contain
confidential data from Job Corps students and applicants.
This statement describes the collection and use of information from Job Corps students and applicants by the
Department of Labor for the Job Corps program.
The Privacy Act of 1974, as amended, requires all Federal agencies, including Job Corps and its agents, to give the
following facts to each person from whom it requires information:
▪ The statutory authority for the request
▪ Why the information is needed
▪ Whether it is voluntary or mandatory to give the information
▪ The effect of not providing information
▪ The use which may be made of the information
▪ Whether disclosure of the Social Security Number (SSN) is mandatory or voluntary, by what status or other
authority the number is solicited, and what uses will be made of it.
These items are more fully explained in the following sections. If you have any questions about your rights and
responsibilities under the Privacy Act, you should ask for assistance from the person assigned to you in Job Corps as a
Counselor or Advisor.
I. The Department of Labor’s Authorization to Collect Information
Job Corps is a part of the Idaho Department of Labor. The Department’s authority to collect information from Job
Corps applicants and students is found in the Workforce Innovation and Opportunity Act (WIOA) of 2014. The
Department’s authority to solicit the Social Security number is found in the Social Security Administration’s
regulation, WIOA and the Job Corps regulations under WIOA.
II. Why the information is needed
Job Corps needs information about age, citizenship, school and draft status, health, employability, behavior,
family income, environment, and other matters related to your eligibility, assignment, and progress in Job Corps.
This information may be used to:
▪ Determine whether your educational and vocational needs can be best met through Job Corps or another
program in your home community
▪ Determine your potential assignment
▪ Lay the basis for determining your progress in Job Corps programs and activities
▪ Determine your eligibility to enter Job Corps for health needs (medical, dental, and/or mental health) while a
student, and also to establish and maintain a record of your health care during the period of enrollment in Job
Corps for legal and administrative reasons, e.g., future health care, and indication of quality of health care
▪ Maintain a record of cash, clothing, and other benefits received by the individual
III. Obligatory and Voluntary Information and Possible Consequences of Withholding Information or Providing
False Information
While there are no penalties under the law for refusing to supply information, WIOA requires the collection and
maintenance of a wide range of personal information about you, including your Social Security number, to satisfy
enrollment requirements. Not supplying the needed information could delay or prevent you from enrolling and
participating in Job Corps.
The provision of false information by you could lead to expulsion from the program and/or prosecution under the
U.S. Criminal Code when such information is used to support a fraudulent claim to benefits.
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IV. How the Information is Used
The SSN will be used to payroll allotment, allowances and bonuses. In carrying out its responsibilities under WIOA
to administer the Job Corps Program, the Department of Labor must sometimes disclose data from its records
about you to another agency or individual without your specific written consent. Such disclosures are made for
the following reasons:
▪ In connection with federal litigation, for law enforcement purposes
▪ To the parent locator service of the Department of HHS or to other authorized persons defined by Public Law
93-647
▪ To an information source in connection with personnel, procurement, or benefit-related matters, to a
contractor or their employees, consultants, grantees or their employees, or volunteers with have been
engaged to assist Job Corps in the performance of a contract
▪ For Federal debt collection purposes
▪ If a person about whom records are maintained submits a written request to a Member of Congress or their
staff and that request is forwarded to the U.S. Department of Labor, we may release the information to the
Member of Congress or Congressional staff in response to the inquiry made on behalf of the subject of the
record.
▪ To provide information to the news media or members of the general public for the purpose of promoting the
merits of the program
▪ To provide information to placement and welfare agencies, prospective employers, school or training
institutions to assist in student employment
▪ To provide information to State, Federal, and local law enforcement agencies (including appropriate agencies
which have law enforcement jurisdiction over students on which the center is located) and other government
investigators to assist them in locating a student and/or his or her family
▪ To provide information to parents/guardians regarding students under the age of 18 for performance of
parental rights and responsibilities
▪ To provide information to Job Corps health consultants; Job Corps center Review Board members (in
appropriate disciplinary cases); Stats, county, and local health services personnel; family planning agencies;
and physicians (public or private) to whom a student is referred for diagnosis or to receive treatment to assure
continuance of proper health care, or notification and contact for communicable disease control.
▪ To provide State and local health departments information about all cases of infection or disease that are
required to be reported to them; and infected persons who are unwilling to notify their contacts on center for
the purpose of assisting in the counseling of contact for their protection and care
▪ To provide information to contractors and agencies to enable them to properly administer the program,
including the payment of student allowances and maintenance and disposal of student pay records
▪ To provide information to Federal, State, and local agencies and community-based organizations to facilitate
statistical research, audit and evaluation activities necessary to insure the success, integrity, and improvement
of the Job Corps program and other employment and training programs
▪ To provide the Selective Service System with information which will allow them to register you automatically
for Selective Service when you become 18, if you are male and not already registered
▪ For research purposes
▪ Privacy Act information collected from the student shall not be used in any study or research project unless it
has been approved by the Department, for freely given by the student with his or her consent.
Job Corps has given you a copy of this statement, in accordance with the Privacy Act of 1974, as amended, which
explains the uses that will be made of information that you or others might supply in Job Corps about yourself.
A single copy of this form must be given to the student for personal reference upon enrollment.
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Job Corps Application (College of Eastern Idaho)

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Completed 5 November 2020

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