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Adult Workforce Development Registration

Adult Workforce Development Registration2024-03-29T12:15:46-04:00

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Step 1 of 6 - Your Information

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Your Information

Do you check your email often?*
Address*
MM slash DD slash YYYY
Gender*

Race*
National Origin*
Please check all the boxes that apply*
Have you served or are currently serving in the military?*
Is your spouse currently serving or has he/she previously served in the military?*

Educational Background

Highest Educational Attainment*

Employment Information

Are you currently employed?*
MM slash DD slash YYYY
MM slash DD slash YYYY
Check all the items you currently have:*
Please keep in mind, if you don't have any or all of the following items listed below, it is NOT a problem. We will gladly assist you in obtaining them (*including a bank account, prior to your first payday)
Do you have a resume?*
Max. file size: 256 MB.
What is your transportation needs and capability? Please check all that apply

Home & Surrounding Enviroment

Who lives in your home with you?*
Have you moved in the past 5 years?*
Do you live near public grocery store? (<2 miles)*
Do you live near public library? (<2 miles)*
Do you live near a shopping mall or plaza? (<2 miles)*
Do you live near an unemployment office, workforce center or staffing agency? (<2 miles)*
Do you live near a safe gym, recreation center, or fun hangout spot? (<2 miles)*
Do you get along with everyone in your home? Check the boxes of all the family members you get along with.*
Do you feel safe at home?*
Do you feel safe in your neighborhood? (<2 mile radius)*
Are you happy with your present home and neighborhood surroundings?*
Who usually does the cooking (hot food, full meal)?*

Who usually does the weekly shopping?*

Who usually does minor repairs (e.g., mending a chair, putting up a hook, changing light bulbs) in your household?*

Can you count on getting help from others if you become ill, (both from family members and others) and particularly with practical things?*
Check all that apply
Do you feel that you really could do with help from any of the following at the moment?*
Check all that apply
Please include income of all household members
Are you the head of household?*

Emergency Contacts

Emergency Contact 1 Name*
Emergency Contact 1 Gender*

Emergency Contact 1 Address*
Emergency Contact 2 Name*
Emergency Contact 2 Gender*

Emergency Contact 2 Address*
Please Accept Our Terms*
I hereby give my permission for GROW HOME INC and UNITED WAY OF CENTRAL MARYLAND to use without limitation or obligation, photographs and film footage that may include me for the promotion and programs for the sake of increasing capacity for workforce development efforts and greater equity.

I hereby acknowledge that I have carefully read this Waiver and Registration and am aware that in registering myself or my minor child/ward for participation in the program(s), I am waiving and releasing all claims for injuries myself or my child/ward might sustain arising out of the program(s). I recognize and acknowledge that there are certain risks of physical injury to participants in the program(s) and I agree to assume the full risk of any such injuries, damages, or loss regardless of severity which I or my child/ward may sustain as a result of participating in any of the program(s). I hereby fully release and discharge the GROW HOME INC and its officers, agents, servants and employees from any and all claims resulting from injuries, damages and losses sustained by me or my child/ward, and arising out, connected with, or in any way associated with activities of any of the programs.

I, the undersigned participant agree to these terms of program participation and affirm that I am of 18 years of age or older.
This field is for validation purposes and should be left unchanged.

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©2023 Grow Home
Tel: (667) 653-1982
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Please contact Michael Dorsey at michael@growhomebaltimore.com or (410) 491-0852 to sponsor this event

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