Thank you for your interest in PA CareerLink Philadelphia's Manufacturing Boot Camp. Please complete the application in full.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. At what email address would you like to be contacted?

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* 4. What is your street address?

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* 5. What is the highest level of school that you have completed?

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* 6. In what city do you live?

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* 7. What phone number can you be contacted at? Please indicate one or more if applicable.

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* 8. What is your date of birth? Please indicate month, date, and year. (Ex: 03/25/1980).

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* 9. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 10. What is your gender?

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* 11. Have you ever worked in the manufacturing industry?

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* 12. Do you have any physical limitations that will prevent you from working in the manufacturing industry?

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* 13. Are you willing to complete a drug screening test? This is a program requirement.

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* 14. Are you able to commit to attending Manufacturing Boot Camp every Monday through Friday for 6 weeks (03/11/19 - 04/19/2019)?

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* 15. Are you able to commit to attending daily from 7:30am-11:30am, Monday through Friday?

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* 16. Are you willing to complete assessment tests during the first week of bootcamp to determine eligibility to continue in the bootcamp? These tests include math skills, reading skills, and initial ability to complete tasks in the manufacturing industry.

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* 17. Are you able to bring the following documents on day one of bootcamp? Please mark the box for any items you can bring.

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