Workforce Innovation & Opportunity Act (WIOA) Eligibility Application
Applicant Contact Information
What county do you live in?
*
Choose Your County
Bosque
Falls
Freestone
Hill
Limestone
McLennan
Are you currently registered in WorkinTexas.com?
Yes
No
Not Sure
First Name
*
Last Name
*
Date of Birth
*
-
Month
-
Day
Year
Primary Phone Number
*
Please enter the phone number where you can best be reached.
Email Address
*
Confirmation Email
Confirm your email address.
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your mailing address the same as your physical address?
*
Yes
No
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Applicant Family, Education, Military & Employment Information
Information requested is for reporting and WIOA eligibility purposes only and does not exclude you from services. Verification of information provided will be required and requested by our WIOA Career Specialist after you submit the application.
Are you authorized to work in the US? Verification of work autorization will be required for eligibility.
*
Yes
No
Type the number of persons living in your household, including children, related to you by blood, marriage or adoption.
*
If male, are you registered for Selective Service? Verification of registration for males will be required for eligibility.
*
Yes
No
Not sure
I'm not a male.
Please select the statement that applies to you regarding US Military service:
*
I am on active duty for a branch of the US Military.
I am a veteran of a branch of the US Military.
My spouse is an active member or veteran of a branch of the US Military.
My spouse is an active member of a branch of the US Military, and I am unemployed, underemployed or lost employment as a direct result of relocation to accommodate a permanent change in my spouse's duty station.
None of these statements apply to me.
Please check Yes or No based on how each of the following applies to you:
*
Yes
No
Receiving TANF (currently or in the last 6 months)
Receiving SNAP/Food Stamps (currently or in the last 6 months)
Receiving Unemployment Insurance or exhausted UI Benefits
Receiving Supplemental Security Income (SSI)
Receiving Veteran Benefits
Foster Child/ Runaway Youth/Out of Home Placement
Pregnant/Parenting (under 24 years of age)
Homeless
Disability (including learning disabilities)
Felony/Misdemeanor Arrest or Conviction
History of Substance Abuse
Loss of job due to business closure or downsizing
Drop out High School or Out of School last 3 months
Displaced Homemaker
Highest Education Completed
*
Choose One
No Formal Schooling
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade, No Diploma
High School Graduate
GED or Equivalent
Some College, No Degree
Occupational/Technical/Vocational Degree or Certification
Academic Associate's Degree
Bachelor's Degree
Master's Degree
Professional Doctorate Degree
Academic Doctorate Degree
Don't Know/Not Sure
Are you currently enrolled in school?
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Yes
No
Name of School/Institution
*
Program/Area of Study
*
What is your current employment status?
*
Employed
Unemployed
Laid Off
Terminated
Employed Employer Information
Current Employer's Name
*
Current Supervisor's Name
*
Supervisor's Phone Number
*
Please enter a valid phone number.
Employer's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date
*
-
Month
-
Day
Year
Job Title
*
Job Duties
*
Job Status
*
Full-Time
Part-Time
Average Hours Per Week
*
Wage Per Hour $
*
Total Earnings per Month $
*
Unemployed/Laid Off Previous Employer Information
Previous Employer's Name
*
Previous Supervisor's Name
*
Previous Supervisor's Phone Number
*
Please enter a valid phone number.
Previous Employer's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date
*
-
Month
-
Day
Year
End Date
*
-
Month
-
Day
Year
Job Title
*
Job Duties
*
Job Status
*
Full-Time
Part-Time
Average Hours Per Week
*
Wage Per Hour $
*
Total Earnings per Month $
*
Reason for Unemployment/Laid Off
*
Terminated Previous Employer Information
Previous Employer's Name
*
Previous Supervisor's Name
*
Previous Supervisor's Phone Number
*
Please enter a valid phone number.
Previous Employer's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date
*
-
Month
-
Day
Year
End Date
*
-
Month
-
Day
Year
Job Title
*
Job Duties
*
Job Status
*
Full-Time
Part-Time
Average Hours Per Week
*
Wage Per Hour $
*
Total Earnings per Month $
*
Reason for Termination
*
End Employer Information
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Sign & Submit
Please sign and submit your application. Our WIOA Career Specialist will contact you at the information provided for additional elgibility and verification information.
Applicant Signature (Use your finger or mouse to sign)
*
Clear
Date/Time Submitted
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Month
-
Day
Year
Minutes
AM
PM
AM/PM Option
Submit
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