| Word of Life Outreach International - Training Center Registration Form (Please Fill Out All Information: Please copy and print this form, sign, and send it to our address listed below.) NAME:_____________________________________________________ ADDRESS:________________________________________________________ CITY, STATE, ZIP CODE:____________________________________________ PHONE NUMBER:___________________________ FAX:________________________________ CELL:_________________________________ EMAIL:___________________________________ ARE YOU EMPLOYED? If SO WHERE?________________________________ ADDRESS OF EMPLOYER:____________________________________________ PERSONAL INFORMATION: SOCIAL SECURITY NUMBER:_________________________________ PLACE OF BIRTH:____________________________________________ DID YOU GRADUATE FROM HIGH SCHOOL?____________ DIPLOMA:_______ GED:_________ OTHER:________ IF SO, NAME OF SCHOOL:_____________________________ ADDRESS:______________________________ CITY, STATE, ZIP CODE:__________________________________________ ARE YOU A CITIZEN OF THE USA?_______________ HAVE YOU EVER SERVED IN THE ARMED SERVICES?__________ IF SO, NAME OF SERVICE:__________________________ DATE OF ENLISTEMENT:__________________________ DATE OF DISCHARGE:____________________ POSITION TITLE:________________________ DUTIES:__________________________________________________________ __________________________________________________________________ __________________________________________________________________ HAVE YOU ATTENDED COLLEGE?_______ IF SO, LIST: (College Universiy or Professional Schools) NAME OF SCHOOL:___________________________________________ LOCATION:____________________________________ CITY, STATE, ZIP:_________________________________________ COURSE NAME:_______________________________________ CERTIFICATE/DEGREE:______________________________________________ DATE:______________________________ NAME OF SCHOOL:___________________________________________ LOCATION:____________________________________ CITY, STATE, ZIP:_________________________________________ COURSE NAME:_______________________________________ CERTIFICATE/DEGREE:______________________________________________ DATE:______________________________ NAME OF SCHOOL:___________________________________________ LOCATION:____________________________________ CITY, STATE, ZIP:_________________________________________ COURSE NAME:_______________________________________ CERTIFICATE/DEGREE:______________________________________________ DATE:______________________________ NAME OF SCHOOL:___________________________________________ LOCATION:____________________________________ CITY, STATE, ZIP:_________________________________________ COURSE NAME:_______________________________________ CERTIFICATE/DEGREE:______________________________________________ DATE:______________________________ NOTE: For additional courses, please write on paper and send to us with application. JOB RELATED QUESTIONS: WHAT TYPE OF JOB ARE YOU LOOKING FOR?______________________ WHAT TYPE OF JOB DO YOU WANT TO TRAIN IN?________________________ ________________________________________________________________________ WHAT ARE YOUR SHORT TERM GOALS?___________________________________ _________________________________________________________________________ WHAT ARE YOUR SHORT TERM GOALS?___________________________________ _________________________________________________________________________ YOUR SKILLS (name skills you are experienced in): _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ JOB HISTORY: LIST FOUR JOBS OF EMPLOYMENT, STARTING FROM MOST RECENT: NAME OF EMPLOYER:________________________________________ ADDRESS OF EMPLOYER:____________________________________________ (including city, state, zip) WORKED FROM: (mo/day/year)____________________ TO: (mo/day/year)________________ JOB TITLE:___________________________________ DUTIES INCLUDED:_______________________________________________________ __________________________________________________________________________ __________________________________________________________________________ ___________________________________________________________________________ NAME OF EMPLOYER:________________________________________ ADDRESS OF EMPLOYER:____________________________________________ (including city, state, zip) WORKED FROM: (mo/day/year)____________________ TO: (mo/day/year)________________ JOB TITLE:___________________________________ DUTIES INCLUDED:_______________________________________________________ __________________________________________________________________________ __________________________________________________________________________ ___________________________________________________________________________ NAME OF EMPLOYER:________________________________________ ADDRESS OF EMPLOYER:____________________________________________ (including city, state, zip) WORKED FROM: (mo/day/year)____________________ TO: (mo/day/year)________________ JOB TITLE:___________________________________ DUTIES INCLUDED:_______________________________________________________ __________________________________________________________________________ __________________________________________________________________________ ___________________________________________________________________________ NAME OF EMPLOYER:________________________________________ ADDRESS OF EMPLOYER:____________________________________________ (including city, state, zip) WORKED FROM: (mo/day/year)____________________ TO: (mo/day/year)________________ JOB TITLE:___________________________________ DUTIES INCLUDED:_______________________________________________________ __________________________________________________________________________ __________________________________________________________________________ ___________________________________________________________________________ SIGNATURE OF APPLICANT:________________________________________________ DATE:_____________________________ All information used in this form is to help to better train you in the skills you want to fulfill. All information will be kept confidential. We want to help you suceed in finding the perfect job for you and to be able to train you and place you in the job that matches your skills. Please print this application out, sign and send to our address below: Word Of Life Outreach International - Training Center Jerry Brooking 335 12th Street The Dalles, OR 97058 P.O. Box 587 The Dalles, OR 97058 For more contact information Click here: CONTACT INFORMATION |