The following screening assessment is used to review your eligibility and suitability for the ACE Program.

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* 1. First Name:

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* 2. Middle Initial:

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* 3. Last Name:

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* 4. Full Social Security Number:

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* 5. Date of Birth:

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* 6. Physical Address:

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* 7. County of Residence:

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* 8. City:

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* 9. State:

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* 10. Zip code:

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* 11. Personal email:

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* 12. Phone number:

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* 13. Alternative phone number:

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* 14. Please choose the training program you are interested in: (Please visit our website for program descriptions)

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* 15. Have you registered in EmployFlorida.com? Go to this page to register;  https://www.employflorida.com/vosnet/Default.aspx

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* 16. Are you a U.S. Citizen or legally authorized to work in the U.S.?

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* 17. All males born January 1, 1960 or later are required to register with Selective Service. If applicable, have you completed this registration? To check your registration please visit sss.gov.

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* 18. Do you consider yourself to have a disability?

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* 19. Are you in the military, an eligible veteran, or spouse of an eligible veteran?

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* 20. Are you currently Active Duty military spouse who is unemployed/underemployed?

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* 21. Are you currently working?

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* 22. Rate of pay?

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* 23. How many hours do you work per week?

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* 24. Are you able to work full-time?

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* 25. Have you been convicted of a Felony

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* 26. If yes, please list year and location of conviction.

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* 27. Are you pregnant or have a dependent child?

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* 28. Do you currently reside in a homeless shelter or are you currently homeless?

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* 29. Are you currently in school?

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* 30. If applicable, what type of school are you currently in?

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* 31. Do you have a high school diploma?

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* 32. Have you completed any advanced training? Please list type and training and dates.

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* 33. Do you currently receive or are a member of a household family that receives Food stamps or received Food stamps during the previous six months?

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* 34. Are you currently receiving TANF/Cash assistance?

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* 35. Are you currently in foster care or aged out of  foster care?

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* 36. What is your family size? (This includes the total number of people in your family= all individuals in your household related by blood, marriage or court decree.)

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* 37. What is your total annualized household income before taxes? (Family income = all those living in a household related by blood, marriage or court decree.)

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* 38. Do you file taxes by yourself or with your parents?

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* 39. Do you provide 50% or more of your living expenses?

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* 40. Type of income? (Please select all that apply)

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* 41. Do you use tobacco products, such as cigarettes, cigars, or chewable tobacco?

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* 42. If yes to question 41, would you like information on free products and support to help you quit smoking?

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* 43. Do you have reliable transportation to attend school and/or your worksite?

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* 44. What is your method of transportation?  (select on or more of the following)

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* 45. Are you able to commit and go to school 2 days per week and work at an ACE worksite 3 days per week for up to 40 hours per week?

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* 46. Are you able to work 40 hours per week during your ACE experience which will be 8 to 12 weeks long?

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* 47. Are you able to maintain excellent attendance during your ACE training?

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* 48. Do you have a laptop or access to a computer to take online training or virtual work?

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* 49. Do you have internet access where you will complete online training or virtual work?

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* 50. ACE program will upskill you to begin a career path in a demand occupation. Do you agree to seek and obtain employment at the end of your ACE experience?

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* 51. What type of employment are you looking for at the end of ACE?

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* 52. Will you need assistance with a resume and placement at the end of your ACE training through the ACE recruiter?

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* 53. During intake, your application and preparation to start the ACE program, you will be required to participate in the following?

·       Complete application and eligibility

·       Complete assessments such as Wonderlic and Digital Literacy testing

·       Attend CSTB workshops to prepare for your worksite and/or training?

·       Maintain monthly or biweekly contact with your ACE coach?

·       Maintain good attendance in both classroom and worksite training?

Will you be able to complete these tasks?

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