Foundational Skills Participant Application Question Title * 1. Are you currently employed? Yes No Question Title * 2. Please specify current hourly wage? Question Title * 3. If yes to question #1, are you working full-time or part-time? Full-time Part-time Question Title * 4. First Name? Question Title * 5. Last Name? Question Title * 6. Full Social Security Number? Question Title * 7. Date of Birth? Question Title * 8. Personal Email? Question Title * 9. Phone Number? Question Title * 10. Alternative Phone Number? Question Title * 11. Physical Address? Question Title * 12. County of Residence? Question Title * 13. Gender? Female Male Question Title * 14. Family size? Question Title * 15. Number of your dependent children in your household under the age of 18? Question Title * 16. Are you a US Veteran? Yes No Question Title * 17. Character of discharge from Military service? Yes No N/A Question Title * 18. Disabled Veteran? Yes No Question Title * 19. Are you the spouse or dependent of a veteran? Yes No Question Title * 20. Are you a US Citizen? Yes No Question Title * 21. If you answered no to (question # regarding Citizenship) what is your current status? U.S. Permanent Resident Alien/Refugee Lawfully Admitted to the U.S. None of the above Question Title * 22. Have you ever been arrested or convicted of a crime? Yes No Question Title * 23. Highest Education Level Completed? Attained a secondary school diploma Attained a secondary school equivalency Completed on or more years of Post-Secondary education Attained a post-secondary technical or vocational certificate (non-degree) Attained an Associate's degree Attained a Bachelor's degree Attained a degree beyond a Bachelor's degree No education level completed Question Title * 24. List degrees/licenses/certifications that you’ve earned. Specify the year that you received each. Question Title * 25. Do you currently receive (or are a member of a *WIOA Defined Family that receives) Food stamps or received Food stamps during the previous six months? Yes No Question Title * 26. What is your annualized family income? Question Title * 27. Do you or a family member currently receive Temporary Assistance for Needy Families (TANF)? Yes No Question Title * 28. Do you or a family member currently receive Supplemental Security Income (SSI)? Yes No Question Title * 29. Do you currently reside in a homeless shelter? Yes No Question Title * 30. Do you have a disability? Yes No Question Title * 31. Have you been terminated/laid off, are eligible for/exhausted unemployment compensation and are unlikely to return to your previous industry/occupation? Yes No Question Title * 32. Have you been terminated/laid off, or have received a notice of termination/lay off, and have been employed for a minimum of 6 weeks, but are not eligible for unemployment compensation due to insufficient earnings, and are unlikely to return to your previous industry or occupation? Yes No Question Title * 33. Have you been terminated/laid off or have received a notice of termination/layoff from employment as a result of permanent closure or substantial layoff at a plant/facility/enterprise? Yes No Question Title * 34. Has your employer made a general announcement that the facility will close within 180 days Yes No Question Title * 35. Are you an individual who was previously self-employed (with a business license) but are currently unemployed due to general economic conditions or a natural disaster? *Must be able to provide proof of business licenses and tax returns* Yes No Question Title * 36. Have you been dependent on the income of a family member (*WIOA Defined) while providing unpaid services to your family, but are no longer supported by their income and are unemployed/underemployed and are experiencing difficulty in obtaining/upgrading employment? Yes No Question Title * 37. Are you the dependent spouse of a member of the armed forces on active duty and whose family income is significantly reduced because of a deployment/call or order to active duty/permanent change of station or service-connected death/disability of the service member? Yes No Question Title * 38. Are you the spouse of a current member of the military who was forced to leave your employment to follow your spouse due to change in military assignment? Yes No Question Title * 39. Are you a previous member of the military who was discharged from the armed forces under honorable conditions and who did not retire from the military? Yes No Question Title * 40. Are you registered in www.employflorida.com? Yes No Done
