Student Application

Those between 18 and 60 years old are given top priority in this program.

Applicant Information

Full Name *

Email Address *

Street Address *

Apt. Number

City *

State *

Zip *

Birth Date *

Home Phone Number *

Cell Phone Number

If you have no phone, at what number can we reach you?

How did you hear about CWJC? *

Present Situation

Family Status? *

Do you have children? *

Names and Ages of Children living with you?

Christian Women's Job Corps (CWJC) does not provide childcare but we are able to partner with another organization to provide a limited number of childcare scholarships if you qualify and are accepted to the program.

Would you have childcare available while you are attending classes? *

If you do not have childcare are you interested in learning about our childcare scholarships? *

Please note, we observe the Huntsville City Schools calendar for the three Huntsville sites and the Madison City Schools calendar for the Madison site. If your child attends school in another system, please plan accordingly.

Do you regularly attend church? *

Church name and location?

Please note, church attendance is not a requirement to enter the CWJC program.

Health

What would you say your health is? *

Education

Have you graduated from high school? *

If you have earned your GED, please enter the date

Would you like to participate in the CWJC GED tutoring program? *

Have you ever been enrolled in a GED program? *

How 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?

Have you completed any training courses? *

If 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 History

Are you currently looking for work? *

If yes, what type of job?

Please list past jobs you have had, starting with the most recent:

Job #1

Job Title? *

Date Started? *

Date Left? *

Company Name? *

Supervisor's Name? *

Address of Company? *

Your duties? *

Why did you leave this job? *

Job #2

Job Title? *

Date Started? *

Date Left? *

Company Name? *

Supervisor's Name? *

Address of Company? *

Your duties? *

Why did you leave this job? *

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.

Future Plans

CWJC of Madison County works with women 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 CWJC to do for you? *

Transportation

Would you be able to provide your own transportation to classes for the entire session? *

CWJC is unable to provide transportation to classes.

If you use public transportation, would you like to learn more about assistance with bus tickets? *

Choose one. *

CWJC Classes Offered

First Baptist Church
600 Governors Drive
Day Class: 8:30 AM to 2:00 PM, Tuesday - Thursday
*You must have a high school diploma or GED to attend this site.

Whitesburg Baptist Church Pulaski Pike Campus
3911 Pulaski Pike
Day Class: 8:30 AM to 2:00 PM, Monday - Wednesday
*High School graduates of those with a GET may attend this site as well as those who need to take the GED.

Union Hill Primitive Baptist Church
2115 Winchester Road
Evening Class: 6:00 PM to 8:30 PM, Mondays & Thursdays
*You must have a high school diploma or GED to attend this site.

Heritage United Methodist Church
29768 Huntsville Browns‐Ferry Road Madison, AL
Day Class: 10:15 AM to 2:30 PM, part-time, Mondays & Tuesdays
*You must have a high school diploma or GED to attend this site.

Choose Class *

References

List three persons who are not related to you that CWJC has your permission to contact for a reference. Please include work related references (coworker or supervisor).

Reference #1

Name? *

Relationship? *

Phone Number? *

Reference #2

Name? *

Relationship? *

Phone Number? *

Reference #3

Name? *

Relationship? *

Phone Number? *

I am willing to be drug tested (at the expense of CWJC) to enter the program? *

According to CWJC policy, I will be suspended if a drug or alcohol addiction occurs while I am participating in the Christian Women's Job Corps of Madison County.

Enter Full Name to act as e-signature *

Today's Date *

Please leave this field empty.

Student Spring Application

Applicant Information

Present Situation

Health

Education

Work History

Future Plans

Transportation

CWJC Classes Offered

References