Student Application Through life and career skills, CJC offers men and women the opportunity to reach their full potential. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Fill out below, or if you prefer, you may download and print the application form. Please email completed forms to recruitment@cwjc.net or mail to: Christian Job Corps P.O. Box 525 Huntsville, AL 35804 Those between 18 and 60 years old are given top priority in this program. Class Location *I understand that classes take place in Huntsville or Gurley, ALApplicant InformationApplicant Name *FirstLastLayoutEmail *Gender? *FemaleMaleIf you have no phone, at what number can we reach you?Date of Birth *Cell Phone Number *Home PhoneAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow did you hear about CJC? *Present SituationLayoutMarriage Status *Please choose an optionMarriedDivorcedSingleWidowedDo you have children? *Please choose an optionYesNoNames and ages of children living with you?Christian Job Corps (CJC) does not provide childcare, but if you qualify and are accepted into the program, we are able to partner with another organization to provide a limited number of childcare.LayoutWould you have childcare available while you are attending classes? *Please choose an optionYesNoNAIf you don't have childcare, are you interested in learning about our childcare scholarships? *Please choose an optionYesNoNAPlease note, we observe the Huntsville City Schools calendar.Do you regularly attend church? *Please choose an optionYesNoChurch name and location?Please note, church attendance is not a requirement to enter the CJC program.Future PlansCJC of Madison County works with women and men who want to make changes which will result in a better quality of life for them and their families. What changes would you like to make to improve your life? *What do you want CJC to do for you? *EducationLayoutHave you graduated from high school? *Please choose an optionYesNoEarned GEDHow many years of school (elementary, high school, college) did you complete? *If you completed college, what did you study?If you completed college, what is your degree?Date graduated or earned GED?Would you like to participate in the CJC GED tutoring program? *Please choose an optionYesNoHave you ever been enrolled in a GED program? *Please choose an optionYesNoHave you completed any training courses? *Please choose an optionYesNoIf yes, name of school, type of training, date(s) completed, and certificates earned?List some of your skills (those learned from jobs, training, use of machinery, or equipment.)Work HistoryPlease list past jobs you have had, starting with the most recent:LayoutJob #1 Job Title *Company Name *Date Started *Date LeftYour duties? *If you're not currently there, why did you leave? *Job #2 Job Title *Company Name *Date Started *Date Left *Your duties? *Why did you leave this job? *Are you currently looking for work? *Please choose an optionYesNoTransportationLayoutWould you be able to provide your own transportation to classes for the entire session? *Please choose an optionYesNoIf you use public transportation, would you like to learn more about assistance with bus tickets? *Please choose an optionYesNoChoose one. *I will drive my carI will use public transportationI will walkA friend/relative will provide transportationReferencesList three people who are NOT related to you that CJC has your permission to contact for a reference. Please include work-related references (coworker or supervisor).LayoutReference #1 Name *Email *Phone *Relationship? *Reference #2 Name *Email *Phone *Relationship? *Reference #3 Name *Email *Phone *Relationship? *AgreementI am willing to be drug tested (at the expense of CJC) to enter the program?YesNoAccording to CJC policy, I will be suspended if a drug or alcohol addiction occurs while I am participating in CJC of Madison County.LayoutEnter full name to act as e-signature *Today's Date *You must provide proof of US citizenship or legal residency (driver’s license, birth certificate, social security card, green card, etc.). This information will be collected at the interview, following the submission of this application. NumbersPhonePhoneSubmit Application
