Workforce Opportunity for Rural Communities Program Application

Educational Background

Please answer the questions relevant to you.
Highest Degree earned:
Employment Information
What is your current employment status?

Unemployed-Full Time StudentUnemployed- Seeking EmploymentEmployed- Part Time or ContractEmployed- Full TimeEmployed- Student
If Unemployed- Seeking Employment, is it due to the impact of COVID-19?

YesNo
Place of employment:
Current Position/Title:

Will you have computer and internet access for the full duration of the program?

YesNo
Commitment & Access
Do you consent to an initial drug screen as part of acceptance to this program with random drug screens throughout the duration of this program?
Disclaimer

By enrolling in this program you give Kentucky Rural Healthcare Information Organization permission to share your information with the U.S. Department of Labor and partners of the Workforce Opportunity for Rural Communities Project such as: Achieving Recovery Together, Appalachian KY Health Care Access Network, AppHarvest, Horizon Health, Kentucky Career Center, Northeast Kentucky Substance Use Response Coalition, Pathways, and St. Claire HealthCare.
Signature: By signing and typing your name below, your name constitutes as an electronic signature.

Clear
Please type your name:
Please verify that you are human*
Should be Empty:

Application for Admission