Name *
Name
Address
Address
Age Range *
Phone *
Phone
Data Available to Begin Training *
Data Available to Begin Training
How did you hear about Change One Thousand? *
Please select all that apply
You would like to pursue a career in the following industries *
You would like to pursue a career in the following industries
Strongly Agree means you would very much like to work in the industry. Strongly Disagree means you have no interest in the industry.
Manufacturing/Transportation
Construction
Healthcare
Information Technology (IT)
Professional Services
Current Employment Status *
Current Student Status *
Not having reliable transportation will not disqualify you from this program.
Having a childcare barrier will not disqualify you from this program.
Please check ALL of the following that apply to you *
Total income earned by you and other members of your household in 2017.
Number of persons living in the home, including spouse and dependent children.
Having a criminal background does not automatically exclude you from the program. Most employers conduct pre-employment background checks, and may hire ex-offenders based upon the nature of the offense.
What is your race/ethnicity? *