Application

Application

This application is for the express purpose of assisting interested individuals to enter into construction trade career fields. The Constructing Hope Pre-Apprenticeship Program provides equal program entrance for all qualified people regardless of race, sex, sexual orientation, gender identity, national origin, political affiliation, or any other non-job related factors.

Qualified applicants must be at least 18 years old, willing to participate in our full program curriculum, participate in the mentor program and you must be physically and mentally capable of performing the job. Collected information will be used to direct the individual to other appropriate or necessary resources. People with a legal history are encouraged to apply.

Who were you referred by?

Contact Information

First Name

Middle Initial

Last Name

Primary Phone Number

Alternate Phone Number

Email

Message Phone (if different)

Street Address

City

State

Zipcode

Mailing Address (if different)

City

State

Zipcode

Personal Information

What is your first language?

Do you have any children? YesNo

If so, how many children?

Gender —Please choose an option—MaleFemaleNon-BinaryOther

If other

Social Security Number

Date of Birth

ID/ Driver's License #

State

Is your license current? YesNo

Is your license suspended?YesNo

Do you have a Hardship Permit?YesNo

If suspended, what do you need to get it reinstated?

Additional Contacts

Please provide printed name. phone number, email, and city/state of three contact persons. People who will know how to reach you and indicate their relationship to you (Mother. Brother. Friend. Etc.):

Name*

Relation*

Phone*

Name*

Relation*

Phone*

Name*

Relation*

Phone*

Demographic Information

Which of the Following Best Describes Your Race/Ethnicity? (Check all that apply):
African American or BlackNative Hawaiian or Pacific IslanderAsianLatinX/HispanicWhite, not of Hispanic OriginNative American/Alaskan NativeOther
Other:
If a member of a Federally Recognized Tribe, which one?

What is your Marital Status?
MarriedDomestic PartnershipMarried-SeparatedDivorcedSingle-No DependentsSingle-Head of Household

Please Check All That Apply
VeteranRefugee or ImmigrantLGBTQ2SIA+Current in Military/or ReservesPerson with Disability

Do you have permanent Housing? YesNo
If No, describe your housing situation

How many people live in your household?

How many dependents/children live in your household?

Do you work with other programs?YesNo
If Yes, which programs? (Please include Program Name(s), Case Manager Name(s), and Phone Number(s))

Law Enforcement Involvement/History

Do you have a criminal history?YesNo

Are you currently on probation/parole?YesNo

If Yes, please print name and contact information for your Parole/Probation Officer:

Name	Phone Number

What offense resulted in your most recent prison or jail stay? (Ex. possession of controlled substance, theft, etc.)

Employment Information

What is your employment status at this time? Never EmployedPart-TimeFull-TimeUnemployed

Please provide the following information from your current or most recent employment:

Company Name

Job Title

Start Date

End Date

Wage per Hour

Hours per Week

Weekly Income

Annual Household Income

Other Income

Please check "No Benefits or all that apply:
No BenefitsHealth/MedicalDentalDisabilityLife InsuranceRetirement/Pension Plan

Do you or anyone in your house receive assistance of the following types? (Select all that apply)
NoneSNAP (food stamps)TANF (cash assistance)Unemployment BenefitsPublic Housing/Section 8 Housing AssistanceMedicaid (Oregon Health Plan, Washington Apple Health)

Education

What is the highest grade or year of school you have completed?
Some CollegeHigh School GraduateGED GraduateWorking on GED (answer questions below)

How many terms completed(If some college )?
Up to 1 yearBetween 1 and 2 yearsBetween 2 and 3 yearsBetween 3 and 4 yearsOther
Other (If some college ):

Highest grade completed( If GED Graduate or working on GED)?
7891011Other
Other ( If GED Graduate or working on GED):

What GED tests have you completed( If working on GED)?
Mathematical ReasoningReasoning through Language ArtsSocial StudiesScienceNone

Trades of Interest

Check all that apply
CarpenterCement MasonElectricianPlumberHeavy Equipment OperatorLaborerMechanicPainterPile DriverOther
Other:
Any additional information we should know?

Please Read and Sign Below:
I understand that upon acceptance into Constructing Hope, I am making a three-year commitment to remain in contact with program staff for ongoing support and career advancement services. I agree to report my income (wages and hours worked) to the program staff every quarter.

I hereby certify to the best of my knowledge that the information herein is true and accurate and I understand that the information supplied is subject to verification.

Signature

Date