Marine Trade Training Course Information

Your First Name:	Required!
Your Last Name:	Required!
Contact Email Address:	Required! Not Valid!
Contact Phone Number (include Area Code):	Required!
How did you hear about this training?:	Radio Ad TV Ad Company/Employer Community College Workforce Center Career Fair Online Search/Website Other Other:
Which career fields interests you? (select as many as apply):	CoatingsOutside MachinistMarine ElectricalShip Repair WeldingSheet Metal
Do you have a High School Diploma or GED?:	YesNo Required!
Are you at least 18 years of age or older and a U.S. Citizen?:	YesNo Required!
Do you have a valid Driver's License?:	YesNo Required!
Do you have reliable transportation to the course?:	YesNo Required!
Are you able to attend the class Monday through Friday from 7:00am to 3:30pm?:	YesNo Required!
Will you be able to obtain safety shoes for the course?:	YesNo Required!

Employment Experience

Please describe your employment history and the skills you have developed in those jobs. Please provide information from AT LEAST one previous employer. If you have no prior work experience, please list a personal reference, previous internship, or enter “n/a” if not applicable.

Employer #1

Company Name:	Required!
Job Title:	Required!
Employment Start Date:	Required!
Employment End Date:	Required!
Job Duties and Skills:	Required!
Reason for Leaving:

Employer #2

Company Name:
Job Title:
Employment Start Date:
Employment End Date:
Job Duties and Skills:
Reason for Leaving:

Employer #3

Company Name:
Job Title:
Employment Start Date:
Employment End Date:
Job Duties and Skills:
Reason for Leaving:

Education & Training

Technical Trade School

School Name:
School City:
Course of Study:
Year(s) Attended:
Degree/Diploma Received:

High School

School Name:
School City:
Course of Study:
Year(s) Attended:
Degree/Diploma Received:

College

School Name:
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Year(s) Attended:
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Personal Talents and Statement

The PreHire Ship Repair Training courses are designed to help people enter a position in trades work that will provide them with a longterm, stable and rewarding career. Potential students will be selected based on several requirements. Please answer the career interest question below to describe why you believe this is a good career option for you.

Please submit a short statement on the talents and skills you have which make this trade program a good career fit for you.	Required!

Background Information

If you are accepted into this training program, the answers to the following questions will not be shared with prospective employers:

The physical requirements of training for the ship repair industry may include: using respirator equipment, lifting, kneeling, squatting, climbing, working in confined spaces, working in extreme temperatures, etc.

Is there anything that might hinder your abilty to perform the physical requirements of this trades training?:	YesNo Required!
If you answered Yes, please describe:

In order to adhere to the strict safety and quality standards required in the Ship Repair industry, many of the companies who hire students from this program require that their employees are eligible to receive security clearance required by the US Navy. Additionally, the work zone is a drug-free area, and therefore you must pass a drug screening in order to qualify for this training course. The following questions indicate a minimum level of conduct required to enter this training program:

If you took a test for illegal drugs, are you confident you would pass it?:	YesNo Required!
Have you been convicted of a misdemeanor in the past three years? If YES, please see comments section below:	YesNo Required!
Have you ever been convicted of a felony? If YES, please see comments section below:	YesNo Required!
If you answered YES to either of these questions, please describe the infraction. Be sure to include WHEN (year) it occured:
Upon request, will you be willing to submit a background check?:	YesNo Required!