Volunteers helping the unemployed transform their lives!
PROFILE
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Work & Learn, Inc. Profile This Information helps Work&Learn assist you in training classes. Please be accurate and complete. If you have a resume, email it to WorknLearninc@mail.com. |
Name _____________________________________________________
Address ___________________________________________________
City______________________________ Zip _____________________
Phone(s) __________________________________________________
E-Mail (if any): ___________________________________________________________
Church Affiliation (if any):
_________________________________________________________________
Are you a United States Citizen? Yes No
If not, can you provide residency papers? Yes No
Do you have? U.S. Social Security Card? Yes No
Driver’s License? Yes No Non-Driver ID? Yes No
Resume? Yes No If Yes, please attach your Resume or email it to WorknLearninc@mail.com.
Are you receiving public assistance? Yes No Food Stamps? Yes No Disability? Yes No
Is there anything we should know that might make it difficult for you to participate in the classes?
__________________________________________________________________
__________________________________________________________________
Emergency
Contact: ___________________________________________________
Phones ___________________________________________________
Educational Background
Circle highest grade completed 4 5 6 7 8 9 10 11 12
GED Vocational Training College
Passed GED in Year _________
High School ________________________________
City, State ___________________________________
Enrolled From Year ____________ To Year ______________. Graduated? Yes ____ No ____
If you received education or training other than high School or GED, what college or vocational training facility did you attend?
__________________________________________________________________
Training Facility or College Name City, State
Enrolled from __________________________ to ___________________________________
Did you receive a certificate or diploma from this college or training facility?
Yes ____ No ____
If yes, what training/degree did you receive?
__________________________________________________________________
Previous Work or Volunteer Experience List your last four employers, starting with your most recent or current employer. Include military and volunteer experience. Be as complete as possible.
Business Name: __________________________________________________________________
Address: __________________________________________________________________
Phone: __________________________________________________________________
What is/was your job title? __________________________________________________________________
What duties did you perform? _________________________________________________________________
__________________________________________________________________
Who is/was your supervisor? __________________________________________________________________
Employed from ________________________ to __________________________
If you are no longer employed here, why did you leave?
Business Name: __________________________________________________________________
Address: __________________________________________________________________
Phone: __________________________________________________________________
What is/was your job title? __________________________________________________________________
What duties did you perform? __________________________________________________________________
__________________________________________________________________
Who is/was your supervisor? __________________________________________________________________
Employed from _______________________ to ___________________________
Why did you leave?
Business Name: __________________________________________________________________
Address: __________________________________________________________________
Phone: __________________________________________________________________
What is/was your job title? __________________________________________________________________
What duties did you perform? __________________________________________________________________
__________________________________________________________________
Who is/was your supervisor? __________________________________________________________________
Employed from _______________________ to __________________________
Why did you leave?
Business Name: __________________________________________________________________
Address: __________________________________________________________________
Phone: __________________________________________________________________
What is/was your job title? __________________________________________________________________
What duties did you perform? __________________________________________________________________
_________________________________________________________________
Who is/was your supervisor? __________________________________________________________________
Employed from ______________________ to ___________________________
Why did you leave?
Security Have you ever been convicted of a felony and/or served time in the past seven years? Yes__ No__
If yes, please describe below. Providing this information will not disqualify a person from Work&Learn™ and may help in obtaining successful employment.
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Current Employment Status Check all that apply.
Unemployed_____ Part-time job_____ Full-time job_____ Independent Contractor _____
Current Marital/ Family/Housing Status
Married_____ Single______ Divorced ______ Widowed _____
Do you have children? Yes_____ No _____ If yes, how many?_______ Ages ____________________
Housing Arrangements: Rent ____ Own Home_____ Homeless______ Other______________________
Work&Learn™ Training Information
Will you need transportation for your training? Yes_____ No ______
Do you want to get a job? Yes_____ No ______
What is your reason for taking Work&Learn™ mentoring and training? __________________________________________________________________
________________________________________________________________What are some of your SKILLS? (Abilities to perform tasks such as cooking, creating or fixing things)
__________________________________________________________________
What are some of your TALENTS? (Personal gifts you have even if no one had to teach you)
__________________________________________________________________
What is your longer term career goal? __________________________________________________________________
What is your present job or volunteer objective? ______________________________________________________________
__________________________________________________________________
What additional training would you like to get?
_________________________________________________________________
Other Activities/Interests___________________________________________________
_________________________________________________________________
Work&Learn Participant Agreement
As a Participant in the Work&Learn mentoring and training program, I agree with the following course requirements and commit to faithfully carry them out:
- I will do the assignment for each class, seeking help if I need it, and bring with me all materials needed for the class session.
- I will attend all classes on time, mentally prepared.
- I will actively participate in the classes and take responsibility for my learning experience.
- I will complete all worksheets in the Workbook, including the Bible study pages.
- I will contact my Pastor, Mentor, Friend, or Class Leader in advance if I am unable to attend class due to sickness or emergency. Or I’ll call 860-501-9675.
- I understand that any class I miss must be made up in order to qualify for graduation. I will have to attend a future course to graduate if I have to make up more than three classes.
- I understand that perfect attendance will enhance my reputation for reliability.
- I will actively seek employment or training opportunities and I understand that completion of my training in Work&Learn Keys and Steps classes does not guarantee my employment.
- I agree to notify Work&Learn (860-501-9675) starting now and at least up until two years following my graduation of any change in my phone, address, employer, or terms of employment.
Photo Release
I, ________________________________ hereby authorize Work & Learn, Inc. permission to use my likeness in a photograph and/or video in any and all of its publications, including but not limited to all Work & Learn Inc.’s printed and digital publications. I understand and agree that any photograph and/or video using my likeness will become property of Work & Learn, Inc. and will not be returned.
Printed Name_____________________________________________________________
__________________________________________________________________
Signature Date
Work & Learn, Inc., 29 Huntington Street, New London, CT 06320
www.worknlearn.ning.com 860-501-9675 worknlearninc@gmail.com
© 2025 Created by Board of Trustees.
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