Directions for completing the MnDOT-DEED HHCT Contact Information/Application Form

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1 MnDOT/DEED Highway Heavy Construction Training Partnership State Program Administration Minnesota WorkForce Center 540 North Fairview Avenue Suite 100 Saint Paul MN MnDOT-DEED HHCT Program Year 2013 Directions for completing the MnDOT-DEED HHCT Contact Information/Application Form 1. Read the Mn/DOT HHCT Program brochure thoroughly. 2. Read the two FAQ (Frequently Asked Questions) pages thoroughly. 3. Complete the Contact Information/Application form by carefully following the directions on each page of the Contact Information Application form. 4. Don t forget to read, complete and sign the Certification section on the last page. 5. Tear off this title page and the FAQ section and keep those pages. 6. You may submit the remaining Contact Information/Application form by: A. Fax to , or B. the e-form version to or C. Submit the form to a WorkForce Center Representative, or D. Mail to address at top of this page. Please note this application is also used to measure how well you follow directions and your communication skills. Incomplete MnDOT-DEED HHCT Contact Information/Application Forms will not be considered. Unsuccessful MnDOT-DEED HHCT program applicants will not be notified. If you wish to know the status of your application, you must contact the State Program Coordinator directly by phone or by . Priority will be given to applicants who have successfully completed National Career Readiness Certification exams and who have achieved Silver level certification. (See FAQ section) The Highway Heavy Construction Training Partnership, sponsored and funded by the Minnesota Department of Transportation, is designed to encourage the placement of underrepresented minorities and women in construction and highway building occupations associated with state/federally funded construction projects. Graduates of the Partnership Program receive basic training in construction terminology, safety rules, construction site safety, use of hand and power tools, measurements and dimensions in construction, and job retention skills.

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3 MnDOT-DEED Highway Heavy Construction Training Partnership State Program Administration Minnesota WorkForce Center 540 North Fairview Avenue Suite 100 Saint Paul MN Fax MnDOT-DEED HHCT Program Year 2013 Read these FAQs (Frequently Asked Questions) about the MnDOT-DEED HHCT (Highway Heavy Construction Training) Program and the Program Application Form before you complete the Application Form. (Page 1 of 2) Am I applying for a job with MnDOT when I fill out this application form? No. The form is used to help us decide if you will be eligible for a specialized pre-apprentice laborer training program that may help you get an entry-level highway construction job with private construction companies. This is why we are asking certain questions, such as concerning gender, ethnicity and automobile ownership that you don t regularly find on an employment application. If your application is accepted, we will schedule you for a final screening interview to determine your eligibility for the training program. The Minnesota Department of Transportation (MnDOT) is sponsoring the HHCT program; the Minnesota Department of Employment and Economic Development (DEED) is coordinating and managing it. Am I guaranteed a job after the training is done? No. However, HHCT Program graduates will have gained highway construction industry knowledge, safety training and insights that will greatly improve their opportunities to get highway construction jobs. While in training, participants will be able to network directly with employers and local union officials and/or representatives. Program graduates will also be able to offer construction employers an HHCT Certificate, Minnesota Flagger Certification and OSHA-30 card as evidence that they have completed the training program. How does the MnDOT-DEED HHCT Program compare to other construction training programs? 1. The HHCT Program is authorized, certified and sponsored by MnDOT to directly reduce the disparity in ethnic minority and female workers in Minnesota s highway construction workforce. 2. Program graduates will receive Certificates verifying their completion of the MnDOT certified HHCT training. 3. Core Program training is developed and delivered by the St Paul College, recognized as the Number One Community and Technical College in the Nation, according to the Washington Monthly magazine. OSHA certified instructors will deliver OSHA 30 Certification training. Additionally, construction employers and union reps will also participate in delivering the training, thus providing great networking opportunities for HHCT graduates. 4. Program graduates will receive case management, limited financial support and placement assistance through HHCT administration. Graduates will be able to independently use the Minnesota WorkForce Centers vast resources. WorkForce Centers are strategically located throughout the state and offer access to regional career professionals who have substantial experience with local employers and job markets. I have lots of construction experience and training from other agencies. Do I still have to go through the HHCT training in order to receive placement help and other Program benefits? Yes. Students must complete all training. Will I be paid while I attend the training? No. Do I have to pay for the training? No. Can a person with a felony record apply for the Program? Yes. Please note that applicants must include complete details on the application. HHCT interviewees must provide appropriate documentation at the time of the interview. The Mn/DOT-DEED Highway Heavy Construction Training (HHCT) Partnership, funded by the MN Department of Transportation and managed by the MN Department of Employment and Economic Development, is designed to encourage the placement of underrepresented minorities and women in highway construction pre-apprentice laborer occupations associated with state/federally funded highway construction projects. Graduates of the Mn/DOT-DEED HHCT Partnership Program receive basic training in construction terminology, safety rules and construction site safety (OSHA 10 certification), use of hand and power tools, measurements and dimensions in construction, and networking/job search/targeted resume development/job retention skills.

4 MnDOT-DEED Highway Heavy Construction Training Partnership State Program Administration Minnesota WorkForce Center 540 North Fairview Avenue Suite 100 Saint Paul MN Fax MnDOT-DEED HHCT Program Year 2013 FAQs (Frequently Asked Questions) (Page 2 of 2) Can a non-female, non-minority person apply for the Program? No person is limited or prohibited from applying. Eligibility for the final screening interview will be determined by applying Program guidelines,...to reduce the disparity in ethnic minority and female workers in Minnesota s highway construction workforce. What happens after my application is reviewed? If your application qualifies, you will be scheduled for a final screening interview where you will be required to provide supporting documentation and answer several questions. If you pass the interview, if you do not currently possess a National Career Readiness Certification (NCRC) certificate and if time permits, you will be scheduled for NCRC testing at one of the HHCT district sites. NCRC testing verifies your math, reading and information locating abilities. Please note that applicants who currently possess and declare Silver NCRC Certification or higher on the HHCT application will be prioritized for interviews; you may also arrange for free NCRC testing at any time at a Minnesota WorkForce Center. You should have very good computer skills to participate in NCRC testing. You must have an active account to be considered for the HHCT program; you will receive by HHCT program information and an ID/password for online NCRC practice tests. You will have one opportunity to complete the NCRC test and achieve a sufficient score; no retesting will be permitted. If your test score is sufficient and completed in time, the MnDOT-DEED HHCT Program training will be scheduled at one of the HHCT district sites. If my HHCT Application is declined or my NCRC score is too low, what other opportunities are available? 1. It may be helpful to speak with a Minnesota WorkForce Center Representative to find information about alternative training and apprenticeship programs. Some training programs provided by schools and/or community agencies may require fees and/or tuition. 2. MinnesotaWorks.net offers powerful resources and information about job opportunities and current apprenticeships. 3. Additional trade apprenticeship information is available at Will I be notified if my HHCT Program Application is declined? Because of the tremendous number of applications we receive, we encourage interested applicants to call to receive information about their current HHCT program application status. Successful applicants will receive an interview scheduling letter. If I make a mistake on the HHCT Program Application and I m declined, can I fill out another application? If you wish to complete another application, we may consider your new application for the next HHCT Program Year. If I miss my scheduled HHCT interview, can I ask for another one? Because of the large number of HHCT program interviews we schedule we may, at our option, grant one (1) request for interview rescheduling. The candidate must have a substantial reason for missing the original/first interview and must call within 24 hours of the original/first interview date. Rescheduling will be at the sole discretion of the State Program Coordinator. Why do I need to declare vehicle ownership and insurance? Construction work requires independent transportation. Where do I send the completed application? You may mail or fax it to the address/fax number at the top of this form. The Mn/DOT-DEED Highway Heavy Construction Training (HHCT) Partnership, funded by the MN Department of Transportation and managed by the MN Department of Employment and Economic Development, is designed to encourage the placement of underrepresented minorities and women in highway construction pre-apprentice laborer occupations associated with state/federally funded highway construction projects. Graduates of the Mn/DOT-DEED HHCT Partnership Program receive basic training in construction terminology, safety rules and construction site safety (OSHA 10 certification), use of hand and power tools, measurements and dimensions in construction, and networking/job search/targeted resume development/job retention skills.

5 MnDOT/DEED HIGHWAY HEAVY CONSTRUCTION TRAINING PROJECT CONTACT INFORMATION AND APPLICATION This Contact Form/Application must be filled accurately, completely, and only by the Applicant. Failure to comply with the above directions may result in the Applicant being dismissed from consideration. PERSONAL / GENERAL INFORMATION Name: Last, First, Middle Initial Address: Street Number, Apartment/Unit # years at this address: City, State and Zip Code) Home Phone Number: ( ) Cellular Phone: ( ) Social Security # - - (must be current and active) Do you possess the following? (Check all that apply): Driver s License Yes or No If yes, check class Class A Class B Class C Class D Driver s License Number: State: Expiration Date: Do you own an automobile? Yes or No If yes, Make, year and model Car Insurance Company/Agency (Identify) Policy # Are you a US Citizen? Yes or No If not, are you authorized to work in the U.S.? Yes or No Alien Card # EDUCATION / TRAINING High School/GED Vocational Cert Associate Degree Four Year Degree Apprenticeship School City/State Program/Major Years Attended Graduated? Y/N Have you successfully completed the three-part National Career Readiness Certification exam? Yes or No If yes, write in your final scores and include a copy of your certificate: Reading Math Information Are you a Military Service Veteran? Yes or No If yes, do you have a service-related disability? Yes or No List all languages you speak: Occupational licenses and trade/technical certificates: What skills, knowledge, and training would you bring to a highway construction occupation? What construction or building equipment/machinery have you operated professionally?

6 MnDOT/DEED HIGHWAY HEAVY CONSTRUCTION TRAINING PROJECT CONTACT INFORMATION AND APPLICATION PG 2 This Contact Form/Application must be filled accurately, completely, and only by the Applicant. Failure to comply with the above directions may result in the Applicant being dismissed from consideration. EMPLOYMENT HISTORY Begin with your most recent paid or volunteer job and list all the jobs you ve had in the last 10 years. Do not leave gaps in your history or any blank/incomplete areas. All areas must be filled in accurately and completely. If you require additional space to list your work history, photocopy this page and include the additional copies with your application.. Employer Date Started Date Ended Street Address City State Zip Job Title Hours per week Hourly wage Phone Brief description of duties and responsibilities DO NOT WRITE IN, SEE RESUME Why did you leave? Employer Date Started Date Ended Street Address City State Zip Job Title Hours per week Hourly wage Phone Brief description of duties and responsibilities DO NOT WRITE IN, SEE RESUME Why did you leave? Employer Date Started Date Ended Street Address City State Zip Job Title Hours per week Hourly wage Phone Brief description of duties and responsibilities DO NOT WRITE IN, SEE RESUME Why did you leave? APTITUDE / APPLICABLE BACKGROUND Highway construction jobs are physically strenuous and demanding, and often include exposure to temperature and weather extremes. You will likely be required to lift 70lbs or more occasionally and 40lbs regularly. You will frequently bend, reach, climb, crawl, stretch, pull, and carry equipment and materials. Will you be able to perform these functions repeatedly and under severe temperature and weather extremes? Yes or No Will you be able to work more than 40 hours/week and 8 hours/day, if required? Yes or No Have you been convicted of a felony and/or a major misdemeanor in the last 10 years? Yes or No If yes, please describe completely. (Do not write, Will explain during interview ) Are you currently restricted by court order, including work release, parole, or probation? Yes or No If yes, please describe completely. (Do not write, Will explain during interview )

7 MnDOT/DEED HIGHWAY HEAVY CONSTRUCTION TRAINING PROJECT CONTACT INFORMATION AND APPLICATION PG 3 This Contact Form/Application must be filled accurately, completely, and only by the Applicant. Failure to comply with the above directions may result in the Applicant being dismissed from consideration. Do you have restrictions imposed on your Driver s License or your use of an automobile? Yes or No If yes, please describe completely. (Do not write, Will explain during interview ) Are you registered in and using the MinnesotaWorks.net program for job search? Yes or No Why should we consider you for the MnDOT/DEED Highway Heavy Construction Training Program? Tell us why you would be a great candidate for the training program, but don t use trite or overused phrases that are copied-and-pasted from a text and don t really mean anything. Convince us! Be original and creative! CERTIFICATION AND ELIGIBILITY DATA I certify by signing and dating below that the information contained on all pages of this Contact Information/Application Form is complete and accurate to the best of my knowledge, and I understand that the giving of false or incomplete information in any section of this Form would be cause for denying participation in the MnDOT/DEED Highway Heavy Construction Training Program. I understand that additional screening for and determination of Program eligibility will be performed by the Minnesota WorkForce Center and the MnDOT/DEED Highway Heavy Construction Training State Program Coordinator. Applicant s Signature: Date: We are an Equal Opportunity Employer and Service Provider and are committed to recruitment, hiring, training and promotion of persons without regard to race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, disability, sexual orientation, veteran status or age. Access to and eligibility for some specialized programs and services, such as the MnDOT/DEED Highway Heavy Construction Training (HHCT) Program, may be limited to specific populations or demographics. PLEASE NOTE THAT YOU ARE PROVIDING INFORMATION IN THE FOLLOWING SECTION THAT WILL BE USED TO DETERMINE MnDOT/DEED HIGHWAY CONSTRUCTION TRAINING PROGRAM ELIGIBILITY. IF YOU DECIDE NOT TO PROVIDE THE REQUESTED INFORMATION, WE WILL NOT BE ABLE TO DETERMINE YOUR ELIGIBILITY FOR THE PROGRAM. THIS INFORMATION WILL REMAIN CONFIDENTIAL AND WILL BE USED TO DETERMINE PROGRAM ELIGIBILITY Please check the appropriate boxes: Program Admin Office Use Only Gender: Female Male With which racial/ethnic group do you identify yourself? If the group appropriate for you is not listed, please check the one that comes closest. Please select only one group. Asian, Pacific Islander Native American or Alaskan Native Hispanic/Latino Black/African American White FLAG LIC AG XO XO FAUX LIC ISSUE EMP FAUX NCRC PASS HHCT Program participants who receive some types of government sourced financial assistance or support may be eligible for additional financial incentives from the HHCT Program. Are you receiving funds or benefits from any of the following assistance/support or subsidization programs? MFIP Section 8 Food Stamps Medical Assistance Social Security Disability Unemployment Insurance If you have any questions concerning the MnDOT/DEED HHCT Program or this application, please review the HHCT FAQ Sheet, see a local MnDOT/DEED HHCT Program Representative, or contact the State Program Coordinator at or MnDOT/DEED HHCT Project Contact Information and Application Program Year 2013 REV 2/1/2013 chs CAR NCRC SUB OTHER NOTIFICATION ACCEPTED DECLINED DISTRICT FWRD

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