Work and Learn Inc.

Volunteers helping the unemployed transform their lives!

PROFILE

 

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.

Incident

Year

City, State

Charge

 

 

 

 

 

 

 

 

 

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:

 

  1. 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.

 

  1. I will attend all classes on time, mentally prepared.

 

  1. I will actively participate in the classes and take responsibility for my learning experience.

 

  1. I will complete all worksheets in the Workbook, including the Bible study pages.

 

  1. 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.

 

  1. 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.

 

  1. I understand that perfect attendance will enhance my reputation for reliability.

 

  1. 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.

 

  1. 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

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