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Please complete this application to be considered for the MaturityWorks program.

* First Name
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* Last Name
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* Home Phone
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* Email as emailaddress@xyz.com
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* Address 1
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Address 2
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* City or Town
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* State
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* Zip Code
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* Cell Phone
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* Are you age 55 or older? If no, you are not eligible for the program at this time.
* Are you currently employed? If yes, you are not eligible for the program at this time.
* Have you are your spouse served in the U.S. Military?
Is your discharge other than dishonorable?
* Have you ever been enrolled in any Senior Community Service Employment Program?

The next 3 questions are optional. Answering this information will help us meet service requirements to target populations.

Are you age 65 or older?
Ethnicity: Hispanic, Latino or Spanish origin?
Race: (Check as many as apply)

POST-PROGRAM GOALS

* What is your goal after completing the program? (Check one)
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* How many hours do you want to work each week? (Check one)
* What is your employment income goal? (Check one)
* How far from home are you willing to travel for employment? (Check one)

EMPLOYMENT AND TRAINING GOALS

* List the top three (3) types of positions are you seeking.
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* Do you have experience working in any of the jobs/occupations you listed above?
* What types of training do you feel you need?
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SERVICES CURRENTLY BEING USED

* During the past 12 months, I received services for the following: (Check all that apply)
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* Are you enrolled in any benefit program that might be impacted if you earn an income such as the earnings gained through full-time employment?
Please explain how benefit programs might be impacted by income. Example: If I earn more than x (enter the dollar amount if known), my x benefit (enter the name of the benefit) will be reduced.
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OTHER AREAS IN WHICH MATURITYWORKS CAN HELP

* MaturityWorks can assist with situations that might prevent someone from getting a job. (Check all that apply)
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EDUCATION AND TRAINING HISTORY

* Do you have a High School Diploma or GED?
What is the highest grade completed?
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* Did you attend college and receive a degree?
Please list any vocational training in which you participated, certificates or licenses obtained, or areas of special interest or abilities
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* Have you registered with your local Job Center (Workforce1, CareerLink, AJC, etc.)?
At which Job Center are you registered?
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* Check all of the education and training activities you think you might need to get a job.
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EMPLOYMENT HISTORY (most recent)

* Please list below your most recent employment history. For each position please list: 1. Employer Name 2. Job Title 3. Start and end month and year
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Please list any other work information, such as internships, volunteering, etc. or enter "N/A" if this does not apply.
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* Which best describes your employment in the last 12 months?
* How do you normally search for a job? (Check all that apply)
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* Do you have a current resume?
* Is your resume electronic?

Above you identified the types of positions you would like to obtain after participating in MaturityWorks. Please rate yourself in the following categories as they relate to those jobs.

* Skills needed for the job you want to get
* Experience needed for the job you want
* History of keeping a job
* Job seeking skills
* Access to reliable transportation (public or private)
* Appropriate appearance and attire
* Verbal communication skills
* Written communication skills
* Computer skills

By clicking on the APPLY button below, you will be applying to MaturityWorks.


Thank you for providing the requested information. Your responses will help determine program eligibility and the types of training and services that will increase your potential to obtain a job in the field of work you identified.


You will be contacted by a local representative.