Application for Cathedral Kitchen s Culinary Arts Training Program

Transcription

1 Applicatin fr Cathedral Kitchen s Culinary Arts Training Prgram Cathedral Kitchen s Culinary Arts Training (CAT) prgram is an Equal Opprtunity Educatinal prgram. Enrllment is ffered n the basis f qualificatins, and withut regard t race, sex, religin, natinal r ethnic rigin, disability, age, veteran status, r sexual rientatin. PLEASE TYPE OR PRINT. Cmplete the entire applicatin. Yu may attach a resume, but yu must still cmplete all questins; r yur applicatin will be deemed incmplete and may nt be cnsidered. Please fill ut each bx; (dn't just indicate See Resume. ). Incmplete applicatins will nt be cnsidered. First Name Middle Name, Last Name Other names under which yu have attended schl r been emplyed: Street Address: City, State & Zip: Scial Security Number: Hme Phne: Cell Phne: Other Phne: Are yu a United States citizen? Yes N If nt, are yu legally entitled t wrk in the US? Yes N D yu have a valid driver s license? Yes N If nt, are yu eligible t apply fr ne? Yes Have yu ever served in the armed frces? Referral Wh referred yu t this prgram? Yes N If YES, list type f service, type f discharge. Name Agency Name & Title f Persn Wh Referred Yu Referral Agency Address, Telephne & Address Telephne EDUCATION Name f Schl City/State Did yu graduate? High Schl: Yes N If N, # f years left t graduate If Yes, date f Graduatin Degree received Majr GED: Yes N Other Schl: Yes N Cllege: Yes N Trade Schl: Yes N Other: Yes N Other credentials/ licenses/ etc., that yu have which are relevant t this prgram- fd service related. SKILLS: List technical skills, trade skills, etc., that are fd service related. Include any relevant cmputer skills, and nte yur skill level (basic, intermediate, expert). Example- Micrsft WORD, Excel, etc 1

2 WORK EXPERIENCE-Please detail yur entire wrk histry. Begin with yur current r mst recent emplyer. If yu held multiple psitins with the same rganizatin, list each psitin separately. Attach additinal sheets if necessary. Omissin f prir emplyment may be cnsidered falsificatin f infrmatin. Please explain any gaps in emplyment. Include full-time military r vlunteer cmmitments. PLEASE DO NOT cmplete this infrmatin with the ntatin See Resume. PLEASE NOTE: Cathedral Kitchen reserves the right t cntact all current and frmer emplyers fr reference infrmatin. Dates Emplyed (mst recent psitin) Frm: T Supervisr s Name, Title and Organizatin Name and Address: Cntact my current references: Reasn fr Leaving: Dates Emplyed (mst recent psitin) Frm: T Supervisr s Name, Title and Organizatin Name and Address: Cntact my current references: Reasn fr Leaving: Dates Emplyed (mst recent psitin) Frm: T Supervisr s Name, Title and Organizatin Name and Address: Cntact my current references: Reasn fr Leaving: 2

3 Dates Emplyed (mst recent psitin) Frm: T Supervisr s Name, Title and Organizatin Name and Address: Cntact my current references: Reasn fr Leaving: Give details f any fd service experience yu have had, including any experience while incarcerated. Disability Status D yu have a disability that limits yur emplyment activities? Yes N (Examples: mental illness, physical disability, substance abuse, develpmental/learning disability). What is yur disability? Have yu applied fr SSI/SSDI/IDA r ther? Yes N If yes, which ne? When? / / Applicatin Status Husing What is yur current living situatin? Street Shelter (specify) Transitinal husing (specify) Halfway huse (specify) Residential treatment prgram (specify) Apartment/huse Subsidized husing Friend s hme Relative s hme Other (specify) 3

4 If yu live with friends r relatives, please prvide the fllwing infrmatin: Name Tel. number Relatinship D yu have a secure place t live fr the next 6 mnths? Yes N If nt, hw lng will yu have secure husing? What is yur plan t find husing after that time? If yu are living in a residential prgram, what is yur mve-ut date? / / What is yur plan t find husing after that date? Family/Children Current Living Arrangements: I live alne married with friends with adult children D yu have children under 18 years f age? Yes N Hw many children d yu have? Are yu a single parent? Yes N Are any f yur children in yur custdy? Yes N Hw many? If nt, why nt? If nt, d yu plan t get them back, and hw? If yu have children under 18 in yur custdy, what are yur childcare arrangements while yu attend schl and while emplyed full-time? _ Are yu respnsible fr any ther family members? Yes N If yes, please explain. Legal Histry D yu have any warrants, upcming curt dates, r legal issues? Yes N If yes, please explain briefly: Have yu ever been cnvicted f a misdemeanr? Yes N Felny? Yes N What were the charges? Were yu incarcerated? Yes N If yes, hw much time did yu serve? If yes, please explain when and why: Are yu n prbatin? Yes N If yes, which ne? Fr hw lng? T whm d yu reprt? hw ften/what time? 4

5 Cntact name: Tel. number Health Histry Have yu ever been diagnsed with any f the fllwing: High Bld Pressure Diabetes Heart Disease Bi-Plar Disrder Depressin Mental/Emtinal Disrder Pst Traumatic Stress Disrder Schizphrenia Anxiety D yu currently see a dctr fr any f the abve disrders? Yes N If yes, please prvide cntact infrmatin: Name Tel. #: Have yu ever been admitted t a mental institutin? Yes N If yes, please prvide cntact infrmatin: Name Tel. #: Please list all medicatins and the reasns that yu are taking them: Medicatin/Cnditin Dsage Prescribing Dctr Date Began Substance Abuse Histry Have yu ever used alchl r any type f legal r illegal substance r drugs? Yes N If yes, please respnd belw. Type f substance r drug Hw ften used Hw much used Date yu last used If yu have a histry f alchl and/r drug abuse, when was the last time yu have been clean r sber? Have yu ever been in a drug r alchl treatment prgram? Yes N If yes, please list them n the chart belw. Prgram Name Inpatient, Outpatient, r Residential (specify) Dates f Attendance Did yu cmplete prgram? 5

6 D yu currently use any type f alchl r drugs? Yes N If yu have used alchl r drugs in the past, hw have yu stayed sber? D yu attend meetings? Yes N D yu have a spnsr? Yes N D yu have a supprt netwrk? Yes N If yes, describe Prgram Requirements Listed belw are sme f the CAT prgram requirements. Please initial after each ne if yu agree t them. I understand that daily attendance is required. I understand that I must be n time and prepared t stay the entire day (8:30am-3:30pm unless ntified therwise). I understand that I am required t remain drug and alchl free. I understand that I must be willing t accept instructin frm all prgram instructrs and CK supervisrs/staff and cmplete all assignments ON TIME. I understand that I must have a willingness t face my persnal challenges. I understand that I will be prvided with a lcker and a lck fr my use while enrlled in the CAT prgram. I understand that CK is NOT respnsible fr any lss, damage, r theft f my persnal prperty. I permit investigatin f all statements included in this applicatin. I understand that the misrepresentatin r missin f facts called fr is cause fr dismissal at any time withut any previus ntice. I hereby give Cathedral Kitchen permissin t cntact schls, previus emplyers (unless therwise indicated), references, and thers, and hereby release Cathedral Kitchen frm any liability as a result f such cntract. Applicant s signature Date / / Spnsr/Service Prvider s signature (if applicable) Date / / Emergency Cntact Infrmatin Name Relatinship Telephne Alternate Telephne Address Return this applicatin t: Cathedral Kitchen 1514 Federal Street Camden, NJ