U.S. EPA Environmental Workforce Development & Job Training Funded by the United States Environmental Protection Agency Participant Application

Transcription

1 Institute of Occupational Safety and Health U.S. EPA Environmental Workforce Development & Job Training Funded by the United States Environmental Protection Agency Participant Application Florida State College at Jacksonville and the City of Jacksonville are pleased to announce that the United States Environmental Protection Agency (EPA) has awarded an Environmental Workforce Development & Job Training Grant for our community. This job training program will provide environmental job training that will facilitate the creation of employment in emergency response, Superfund & Brownfields site remediation and other environmental and green industrial jobs. This program targets unemployed or under employed (20 hours or less a week) participants in North Florida. This 8-week (329 hours) training program consists of the following courses: o Brownfields & Community Redevelopment o American Red Cross First Aid, CPR and AED o OSHA Oil Spill Cleanup o U.S. EPA Lead RRP o Environmental Science and Math o OSHA Hazardous Waste Operator and Emergency Responder o U.S. EPA Hour Health and Safety o Introduction to Environmental Technology o OSHA Construction Industry Safety Card o Environmental Sampling and Analysis o Work Skills Training o Green and Traditional Remediation o Lead Abatement Worker Initial o Confined Space Entry o Deconstruction / Debris Removal o DEP Stormwater Erosion and Sediment Control Inspector o OSHA General Industry Safety Card

2 PARTICIPANT PREREQUISITES o Must be unemployed or under employed o Must be 18 years of age o Must have a high school diploma or high school equivalency certification o Must be physically fit and able to lift at least 30 pounds o Must be able to work in confined areas (not claustrophobic) o Must consent to a criminal background check, disqualifiers to include: Repeated criminal history Sexual types of offenses Violent offenses Theft related offenses o Must consent to a drug urinalysis test o Must pass a Test for Adult Basic Education o Pay any debt owed to the College prior to being accepted into the program APPLICATION PROCESS Step 1: Complete and submit the application and provide copies of required identification listed in the application for screening, by one of the following methods: o Drop off or mail to: o to: Florida State College at Jacksonville Urban Resource Center / Room 205 Attention: Environmental Training Team 601 West State Street Jacksonville, Fl sashbroo@fscj.edu Project Coordinator: Sarah Ashbrook Step 2: Attend a mandatory Environmental Workforce Development & Job Training Orientation and information session (questions & answers). Step 3: Attend an interview process with the Environmental Training Team. Step 4: You will be scheduled to take a Test for Adult Basic Education. Step 5: If you do not pass the Test for Adult Basic Education, you can attend remedial education. Step 6: If you pass the Test for Adult Basic Education, you will be provided directions and instructions for taking a drug urinalysis screening. Step 7: Upon completion of the previous steps, you will have a final interview process and be scheduled for the next available course. (Please continue and carefully complete the participant application. Submit the completed application portion of this packet only) Page 2

3 Must complete all of this application form - PLEASE PRINT CLEARLY Today s Date: Male ( ) Female ( ) Ethnicity (optional): African American ( ) Hispanic ( ) Caucasian ( ) Other( ) American Citizen Yes ( ) No ( ) If no, green card # Number of people in household related by blood, marriage, or decree of court Number of legal residents per household Date of Birth Country of Birth: Are you a military veteran? Yes ( ) No ( ) Type of discharge: Are you registered with WorkSource? Full Name: Social Security Number*: Present Address: Zip Code Phone: Day ( ) Evening ( ) Address: In case of an Emergency, Contact: Relationship: Phone: ( ) EDUCATION (Must possess one of the following) High School Equivalency Certification: (Yes/no) Diploma: (Yes/no) College: (Yes/no) Degree: (Yes/no) Are you currently attending school? Are you interested in pursuing a degree? Do you owe money to Florida State College at Jacksonville? (Yes / No) EMPLOYMENT STATUS (Check one) 1. Currently unemployed ( ) 2. Currently under employed (less than 20 hours per week) ( ) 3. Currently employed part-time (20 or more hours per week) ( ) 4. Currently employed full-time ( ) 5. Temporary lay-off from current job ( ) How did you learn about our program? o Personal referral (please give a name) o Organization or company referral o Other Page 3

4 WORK HISTORY How many jobs have you held? 1. CURRENT EMPLOYER/ PREVIOUS EMPLOYER/Employer s Name: Company Address: Your job title and responsibilities: Supervisor / Phone Number: Full-time ( ) Part-time ( ) Number of hours per week? Start Date and End Date How much did you earn per hour? What did you like most about the job? What did you like least about the job? Reason for leaving 2. PREVIOUS EMPLOYER/Employer s Name: Company Address: Your job title and responsibilities: Supervisor / Phone number: Full-time ( ) Part-time ( ) Number of hours per week? Start Date and End Date How much did you earn per hour? What did you like most about the job? What did you like least about the job? Reason for leaving 3. PREVIOUS EMPLOYER/Employer s Name: Company Address: Your job title and responsibilities: Supervisor / Phone number: Full-time ( ) Part-time ( ) Number of hours per week? Start Date and End Date How much did you earn per hour? What did you like most about the job? What did you like least about the job? Reason for leaving Page 4

5 JOB TRAINING Have you been through any other programs, job training, or otherwise? If so, please list the program name and date U.S. EPA Environmental Workforce Development & Job Training Please explain your knowledge of environmental cleanup. Why do you think you would be an EXCELLENT candidate for the Brownfields Job Training program? Page 5

6 PLEASE STAPLE OR PROVIDE COPIES OF THE FOLLOWING DOCUMENTATION ALONG WITH YOUR APPLICATION. 1. Florida Driver s License or Florida Identification Card with Correct Address 2. Social Security Card 3. Green Card, if not a U.S. Citizen 4. Birth Certificate if U.S. Citizen 5. High School Equivalency Certification, High School, College Diploma DISCLOSURE STATEMENT I hereby certify, to the best of my knowledge, the above information is true. I agree and understand that any willful misstatement of facts may cause forfeiture of my status in the program and could be cause for legal action. I understand the information is subject to verification and agree to provide such documentation as required. I understand disclosure of my SS# is voluntary. Print Name: Date: Signature: Staff member name: Date: Signature: Grant is funded by the United States Environmental Protection Agency *Collection and Use of Social Security Numbers ( Florida State College at Jacksonville is a member of the Florida College System. Florida State College at Jacksonville is not affiliated with any other public or private university or college in Florida or elsewhere. Florida State College at Jacksonville is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools ("SACS") to award the baccalaureate and associate degree. Contact the Commission on Colleges at 1866 Southern Lane, Decatur, Georgia , or call (404) for questions about the accreditation of Florida State College at Jacksonville. The Commission is to be contacted only if there is evidence that appears to support an institution's significant non-compliance with a requirement or standard. Page 6