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

    Message Phone (if different)

    Email*

    Street Address*

    City*

    State*

    Zipcode*

    Mailing Address (if different)

    Personal Information

    Do you have any children?* YesNo

    If so, how many children?

    Gender*

    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.):

    First Name*

    Last Name*

    Relationship*

    Phone*

    First Name

    Last Name

    Relationship*

    Phone*

    First Name

    Last Name

    Relationship*

    Phone*

    Demographic Information

    Which of the Following Best Describes Your Race/Ethnicity?* (Check all that apply):
    African American or BlackNative Hawaiian or Pacific IslanderAsianHispanic OriginWhite, not of Hispanic OriginNative American or Alaskan Native
    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 ImmigrantLGBTQI2-SCurrently in Military/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:

    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 (numbers only)

    Annual Household Income (numbers only)

    Other Income (numbers only)

    Please check any that apply:*
    NoneFullDentalHealthLife InsuranceRetirement/Pension PlanDisability

    Do you or anyone in your house receive assistance of the following types? (Select all that apply)
    SNAP (food stamps)TANF (cash assistance)Unemployment BenefitsPublic Housing/Section 8Medicaid (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

    How many terms completed (If some college)?
    Up to 1 yearBetween 1 and 2 yearsBetween 2 and 3 yearsBetween 3 and 4 yearsBachelor's Degree

    Highest grade completed (If GED Graduate or working on GED)?
    789101112

    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 Driver
    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 agree

    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.
    I agree

    Signature

    Date