Applicant’s Full Name

Parent / Guardian’s Name

School / College Name

My Telephone

My Fax Number

My E-mail

My Graduation Date

  Available for training from:

I want a certificate in

Select Field Computerized Drafting Certificate Computer Software Skills Computer Hardware Certificate Website Development Certificate Electronics Assembly Certififcate Metal Working Certificate Plastic Insert Molding Certificate

I am legally eligible to work in the USA                         Yes     No      

Are you sending your resume by email or fax?               Yes      No

Do you have reliable transportation to go to work ?        Yes     No

Do you have a valid Social Security Number?                Yes      No

Would you pass a drug test which some employers require?   Yes    No

Would you pass a background check some employers require?  Yes   No

I am 18 or over in age Y/N The School Name you attend 

How did you hear about us?

Select Through my school Through friends Through a Rotarian Through your website Thru my church Through Employer Through Parents News Paper Other

Other Comments or Wishes