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Green Reentry Job Training Program Application
Applicants must be formerly incarcerated or justice-involved. All information will be kept confidential. If you would like a paper application or have any questions, please contact
kate@gardentime.us
or (401) 996-4922.
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* Indicates required question
Name
*
Your answer
Address
*
Your answer
Phone number
*
Your answer
Email Address
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Race/Ethnicity (Please tell us how you describe yourself in terms of your race and/or ethnicity. You can choose more than one option.)
*
Black/African-American
White/European-American
Hispanic/Latino
Asian/Asian-American
Indigenous/Native American
Bi-Racial/Multi-Racial
Other:
Required
Gender
*
Your answer
Are you a veteran of military service? (If yes, which branch?)
*
Your answer
In case of emergency, who should we contact? (Name, Phone number & Address)
*
Your answer
Relationship to you?
*
Your answer
What is the highest level of education you have completed?
*
Some high school
Graduated high school
GED Certificate
Some college credits
College degree
Other:
Required
How did you hear about this job training program?
*
Your answer
Do you have any experience working in the green industry (agriculture, landscaping, tree service, etc.)? If so, please describe.
*
Your answer
Have you attended other training programs in the past? If yes, please describe.
*
Your answer
Why are you interested in participating in this job training program?
*
Your answer
Are you available Monday thru Friday from 9 am – 5 pm from September 27 - November 5?
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Yes
No
Other:
How will you get to class?
*
Personal Car
Walk/Bike
Bus
Ride from friend/family
Don't know
Other:
If you have children, do you have sufficient child care coverage during class time(s)?
Your answer
Are you currently on probation or parole?
*
Your answer
Are there any circumstances that might interfere with your participation in the program (restricted travel, mandatory PO appointments during training time, etc.)? Please note that we will work with you to try to accommodate your schedule and restrictions.
*
Your answer
Do you have any health problems or disabilities that may prevent you from fully participating in the training, or that would limit the types of work you are best suited for (can’t lift over certain weight, severe asthma, etc.)?
*
Your answer
Do you have any allergies (food, medicine, certain materials, grass/pollen, etc)?
*
Your answer
Are you currently employed?
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Full-time
Part-time
Temp
Self-employed
No
Other:
Please list your 3 most recent jobs. Include Employer and what Position and Duties you had.
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Your answer
What were your reasons for leaving your 3 most recent jobs?
*
Your answer
Do you have any volunteer or community service experience?
*
Your answer
Do you have a valid driver’s license?
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Your answer
Do you have any other skills or certifications/licenses (CDL, others) that will aid you in your job search?
*
Your answer
What hobbies, sports, or other community activities do you enjoy and actively participate in?
*
Your answer
Which of the following technologies do you have confidence using?
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Smart phone
Computer
Internet
Email
None
Other:
Required
Is there anything else you would like us to know?
Your answer
Note that this training is for formerly incarcerated or justice-involved men and women.
*
I am formerly incarcerated or justice-involved.
I certify that all information on this application is complete, accurate, and true to the best of my knowledge. I also understand that I am not guaranteed employment through completion of the Green Reentry Job Training Program.
*
Yes
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