This 11-week (300 hour) training program consists of the following courses

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1 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 11-week (300 hour) training program consists of the following courses Advanced Training: OSHA 29 CFR : Hazardous Waste Operator and Emergency Responder HAZWOPER Florida DEP Storm water, Erosion, Sedimentation Control Inspector OSHA Disaster Site Worker Environmental Sampling & Analysis OSHA Construction Safety OSHA General Industry Certification OSHA Maritime Industry FEMA: National Incident Management System (NIMS) IS a Certificate FEMA: Introduction to Incident Command System IS100 Certificate EPA 24 Hr. Hazardous Material Technician Collections and Waste Water Training Asbestos Worker Certification EPA Lead Renovator, Repair & Paint (RRP) American Red Cross First Aid, CPR&AED OSHA Blood Bourne Pathogens Awareness Training: Environmental Justice Overview Solid Waste: Deconstruction & Recycling, Green Remediation Technologies Environmental Math & Chemical Safety OSHA Confined Space Entry Green Technology Industry: Urban Agriculture Leaking Underground Storage Tank (LUST)

2 Participant Prerequisites Must be unemployed or under employed. Must be 18 years of age. Must have a high school diploma or high school equivalency certification. Must be physically fit and able to lift at least 30 pounds. Must be able to work in confined areas (not claustrophobic) Must consent to a drug urinalysis test Must pass a test for adult basic education (T.A.B.E) Must consent to a criminal background check Application Process Step 1: Complete and submit this application and provide copies of required identification listed in the application for screening, by one of the following methods: Drop off or mail to: Florida State College at Jacksonville Urban Resource Center Rm102L Attention: EWD&JT Team 601 West State St Jacksonville, Fl to: sarah.ashbrook@fscj.edu Project Coordinator: Sarah Ashbrook Step 2: Attend a scheduled mandatory Environmental Workforce Development & Job Training Orientation and information session (questions & answers). Step 3: Attend a scheduled 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 may attend remedial education and Reapply for future classes. Step 6: Pass the Test for Adult Basic Education. Step 7: Pass a drug urinalysis screening. Step 8: Upon completion of the previous steps, you will have a final interview process and be notified if selected for the next available course. This Job Training program is a Selective Admission Program. PLEASE CONTINUE AND CAREFULLY COMPLETE THE PARTICIPANT APPLICATION. SUBMIT ONLY THE COMPLETED APPLICATION PORTION OF THIS PACKET ONLY.

3 U.S. EPA Environmental Workforce Development & Job Training Program Application Must complete all four pages of this application form PLEASE PRINT CLEARLY Full Name: Today s Date: Gender (Circle One) Male Female Present Address: City State Zip Code Phone: Day - - Evening - - Address: Date of Birth Country of Birth: Social Security Number*: 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 Are you a military veteran? (Circle One) Yes No Type of discharge: If yes, what branch of military did you serve in? Are you registered with Work Source? (Circle One) Yes No In case of an Emergency, Contact Information: Relationship: Phone: - - EDUCATION (Must possess one of the following) High School Equivalency Certification: Yes No High School Diploma: Yes No College: Yes No College Attended Degree: Yes No Degree Obtained Do you owe money to Florida State College at Jacksonville? Yes No Are you currently attending school? Yes No Name of School: Are you interested in pursuing a degree? Yes No EMPLOYMENT STATUS (Circle one) 1. Currently unemployed Yes No 2. Currently under employed (less than 20 hours per week) Yes No 3. Currently employed part-time (20 or more hours per week) Yes No 4. Currently employed full-time Yes No 5. Temporarily laid-off from current job Yes No How did you learn about our program? Personal referral (please give a name) Organization or company referral Other Page 1

4 WORK HISTORY How many jobs have you held? 1. Current employer / Previous employer / Employer s Company Name: Company Address: Your job title and responsibilities: Supervisor / Phone Number: Full-time o Part-time o Number of hours per week? Start Date / / 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. Current employer / Previous employer / Employer s Company Name: Company Address: Your job title and responsibilities: Supervisor / Phone Number: Full-time o Part-time onumber of hours per week? Start Date / / 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 2

5 3. Current employer / Previous employer / Employer s Company Name: Company Address: Your job title and responsibilities: Supervisor / Phone Number: Full-time o Part-time o Number of hours per week? Start Date / / 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 JOB TRAINING Would you be willing to travel and/or relocate for employment? (Circle One) Yes No Do you have a valid drivers license? (Circle One) Yes No Have you been through any other programs, job training, or otherwise? If so, please list the program name and dates Please explain your knowledge of environmental cleanup. Why do you think you would be an EXCELLENT candidate for the Job Training program? Page 3

6 PLEASE STAPLE OR PROVIDE COPIES OF THE FOLLOWING DOCUMENTATION ALONG WITH YOUR APPLICATION. Florida Driver s License or Florida Identification Card with Correct Address Social Security Card Green Card, if not a U.S. Citizen Birth Certificate if U.S. Citizen 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 provides equal access to education, employment, programs, services and activities and does not discriminate on the basis of age, race, color, national origin, sex, disability, religious belief, or marital status. The College Equity Officer has been designated to handle inquiries regarding the non-discrimination policies and may be contacted at equityofficer@fscj.edu. Florida State College at Jacksonville is a member of the Florida College System and 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 Southern Association of Colleges and Schools Commission on Colleges 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 4