AHCS Workforce Readiness Program

Adventist Health Castle

Workforce Readiness Program Application
Your Name *

First NameLast Name
Preferred Name
Date of Birth*

DayMonthYear
Gender*

MaleFemalePrefer not to answer
Ethnicity (check all that apply)*

HawaiianAfrican AmericanAlaskan NativeAsianHispanicCaucasianAmerican IndianPacific Islander
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*

Area CodePhone Number
Home Phone

Area CodePhone Number
Email
example@example.com
Highest Level of Education Completed:

K-89-11High school/GEDCollege-level courses2-year college4-year collegeGraduate school
Current Employment Status:*

Full-timePart-timeSelf-employedStudentUnemployed
If employed, are you a current Adventist Health Castle employee?*

YesNo
If unemployed, reason(s) (check all that apply)

DisabilityJob trainingQuit jobRetiredLaid offNot seeking employmentSeeking employmentOther
Annual family gross income $
Family household size:
# of adults (include self)
# of children (17 and younger)
Please check all that apply:*

First generation to college (Parents have not completed bachelor's degree)Eligible US citizenSNAP/EBT beneficiaryELL – English Language LearnerHomeless or at-risk of becoming homelessWard of the courtFoster/Former fosterEmancipated minorSection 8 recipientIdentified by a partnering/nonprofit program as part of “at-risk” populationName of org
I am interested in:*

Volunteer ServicesReferral to COPE Health ScholarsInternshipsAdventist Health Castle job application assistanceTechnical/Softskills trainingOther
(Optional) Use this box to explain the obstacles you’ve experienced that have hindered you from securing higher-wage employment opportunities and what you’d like to see yourself achieve through the Workforce Readiness Program.
COLLECTION, USE, & DISCLOSURE OF PERSONAL INFORMATION *
*By typing out your name, you acknowledge that it will serve as an electronic signature. Full legal name here*
Today's Date*
*Disclaimer: Adventist Health Castle – Workforce Readiness Program asks for personal information on this intake form to provide personalized services unique to the applicant, which helps Adventist Health Castle monitor and improve the services we offer. Adventist Health Castle – Workforce Readiness Program does not guarantee employment. The applicant agrees the information provided in this application is true to the best of their knowledge. The information provided is subject to review and verification. Information and services can be retracted.
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Adventist Health Castle