The following questions are designed to assess your needs for potential placement in an appropriate program. Please answer thoroughly and honestly to help us better serve you. Providing incomplete or false information may disqualify you from consideration.

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1. To better assist you and expedite your pre-application, please choose your training location if known, or activity of interest.

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2. Enter your first name, last name and middle initial.

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3. Enter the last four digits of your Social Security number. XXX-XX-

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4. Enter your email address.

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5. Enter your phone number with area code. 

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6. Enter your address.

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7. For questions 7 - 10, and Pursuant to 29 CFR 38.41, CareerSource Gulf Coast is required to request demographic information. Information provided is voluntary, kept confidential as provided by law, and will be used only in accordance with the law. Refusal to provide the information will not subject applicant to any adverse treatment.

What is your age?

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8. What is your Race/Ethnicity? Check at least one, and all that apply

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9. Select gender or gender identity in which you most identify.

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10. Considered to have a disability?

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11. What is your primary language?

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12. Do you have an understanding of the English language?

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13. To participate in programs funded by CareerSource Gulf Coast, you must have an active registration in Employ Florida (EF). You may register now or at a later time by accessing EF at www.employflorida.com.

Your pre-application will not be delayed, nor will your eligibility be disqualified for not registering at this time. 

If you have an existing EF account, please enter your EF username:

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14. What is your military status?

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15. Which branch of the military are you serving in/did you serve in?

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16. Are you a military spouse?

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17. For classroom or online training participants only.
What is your program of study?

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18. Have you ever received training assistance from Workforce, Workforce Investment Act (WIA), or Workforce Innovation and Opportunity Act (WIOA) in the past?

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19. For classroom or online training participants only.
Have you lived in Florida for the past 12 months?

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20. Please indicate your marital status:

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21. Are you a citizen of the United States of America OR authorized to work in the United States?

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22. Please indicate your work status.

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23. What is your current employment status?

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24. What is your annual income?

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25. For classroom or online training participants only.
Do you work in your field of study?

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26. Are you currently enrolled in training?

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27. What is your household's approximate annual income?

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28. At any time, have you been convicted of the following:

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29. Please check the following if you are currently receiving assistance:

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30. Please indicate your highest completed education level.

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31. Do you currently have a driver's license?

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32. Which of the following driver's licenses do you hold?

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33. Do you have an occupational license?

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34. Program eligibility requires you to be seeking employment, a  job skills upgrade, or a job promotion. List 3 occupations in which you are interested in pursuing.

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35. Program eligibility requires you to be seeking employment, a  job skills upgrade, or a job promotion. List 3 occupations in which you are interested in pursuing.

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36. Program eligibility requires you to be seeking employment, a  job skills upgrade, or a job promotion. List 3 occupations in which you are interested in pursuing.

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37. Please list your last 3 employers, with the most recent being first.

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38. Please list your last 3 employers, with the most recent being first.

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39. Please list your last 3 employers, with the most recent being first.

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40. By typing your first and last name in the space below, you are indicating the information you have provided is correct to your knowledge.

This Pre-Application in no way guarantees your acceptance as a participant in a program funded by CareerSource Gulf Coast. Your pre-application will be reviewed via Priority of Service in the order it was received. A CareerSource staff member will contact you to discuss your pre-application and clarify any information needed. If funds are not currently available for your eligibility classification, you will be placed on a waiting list in the order your application was received. Please notify this office of any changes in your contact information or if you no longer require assistance.

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41. NOTICE: Information you provide to this agency is CONFIDENTIAL. However, information obtained by this agency about you may be provided to other state or federal agencies in the performance of their official duties according to Federal and State Statutes.

An Equal Opportunity Employer/Program. Auxiliary aids and services are available upon request to individuals with disabilities. All voice telephones may be reached by persons using TTY equipment via the Florida Relay Services at 711.

By typing your first and last name in the space below, you are indicating that you have read and understand this information.

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