Suited for success
Enrollment Application This application must be completed manually and submitted by mail. No electronic version will be accepted. The deadline for applying is April 1 for the September 2010 semester and September 1 for the April Semester.
Semester Selection September 2010 April 2011 Please print clearly and concisely all request information. Training Semester Restart Jumpstart Start-Up Sept. 2010 Mar. 2011 Track: Enrollment:
Your Contact Information First Middle Last Name: Name: Name: Apt. Address: No: Zip City: State: Code: Home Cell Alternate Phone: Phone: Number: Email Best time Anytime Early Address: to Call: Emergency Address: Contac: Phone: Date of Single Involved Married Age: Marital Status: Birth: Separated Divorced Widowed Family & Friends ( Support Group) Spouse Address: Date of Name: Same as mine Birth: Child’s Address: Date of Name: Same as mine Birth: Child’s Address: Date of Name: Same as mine Birth: Child’s Address: Date of Name: Same as mine Birth: Child’s Address: Date of Name: Same as mine Birth: References Reference #1 Reference #2 Reference #3 Name
Address: City
State State: Zip Code: State: Zip Code: State: Zip Code: Zip Code Phone: Cell Phone: Email Address: Years Known Relationship: Barriers to Employment
Last 4 September 2010 Full Name: of Soc. March 2011
Many social service agencies tend to identify the hart to employ as individuals with the following barriers to employment. The goal of this questionnaire is to identify and address any barriers that might prevent you from obtaining meaningful and sustainable employment. Please answer honestly and completely.
Barriers to Employment Advanced Skill Good skills from Basic Skills Poor basic skills No basic skills from prior jobs living life. Good, but not Child Care Day care Not reliable No reliable Traffic Criminal Record No Misdemeanor Felony / Parole Violations. (Police clearance required) Isolated Domestic Violence No Regular incidents Fear for my life incidents. High School Have taken the Education GED Certificate EDP Certificate Diploma GED test before. Very good, Limited, but English proficiency Yes No written and verbal. functioning. Yes, but on Yes, not on Have been in an Mental Illness No medication medication institution. Health Problems: Normal Seasonal On medication for Chronic health None For me illnesses an illness/injury problems Health Problems: Normal Seasonal On medication for Chronic health None For my Family illnesses an illness/injury problems. Multiple learning Learning Disability None ADD ADD and ADHD disabilities Yes, but on Yes, not on Have been in an Mental Illness No medication medication institution. Great sense of Self Esteem Good to Great. Low self esteem No self esteem self Traffic Substance Abuse No Misdemeanor Felony / Parole Violations. (Police clearance required) Borrow a car Public Transportation Own a car Walk when I need to Transportation
Welfare Recipient No Not anymore. Some benefits Yes
Yes, held full- Have held part Work History Limited history No work history time jobs time jobs Skills Questionnaire
Last 4 September 2010 Full Name: of Soc. March 2011
Complete the questionnaire by entering appropriate numbers in columns (a) & (b), based on the following: Source: http://www.york.ac.uk/services/careers/docs/yorkaward/ya-skills-questionnaire.pdf
(a) How important is this skill to you? (b) To what extent do you already possess this skill? 10 – very important / 1 – not at all important 10 – very good at this / 1 – unknown/ very poor (a) – (b) Look out for high positive scores
SKILL a b (a) – (b) Communication Making verbal presentations to groups Making clear & relevant contributions to discussions Negotiating Understanding another language Numeracy & statistics Being able to interpret statistical information in a variety of formats Make fast, accurate calculations Finding & identifying suitable data for making calculations Presenting numerical information to others Information technology Ability to use standard office software applications Ability to present & format information in appropriate ways Ability to search for information using online & database facilities Understanding webpage design Social skills Work effectively within a team Manage, guide, facilitate a group to maximize its success Work with others to generate ideas Ability to clearly transmit a skill or knowledge to others Thinking & problem solving Use creativity to develop new ideas & carry our plans Ability to plan & implement complex tasks & processes Personal Skills Evaluate your own strengths & weaknesses Set your self challenging goals & achieve them Manage your time effectively Demonstrate to others the skills you possess Commercial awareness Having a clear sense of career direction Having an understanding of the workplace Being able to express a business case in appropriate terms Understanding of the current issues facing an employment sector of interest to you
List all office equipment you have used and the level of proficiency.
List any equipment (construction, office, printing) used and the level of proficiency.
Employment History
Last 4 September 2010 Full Name: of Soc. March 2011
Please provide the names and contact information of your three most recent employers Most Recent Employer Employer Period of Employment Name: Hire: Company Address: Zip City: State: Code: Your Number of people you Title: supervised Salary / Hourly Rate Duties: Start: End: Name of Phone Supervisor Number: Next Employer Employer Period of Employment Name: Hire: Company Address: Zip City: State: Code: Your Number of people you Title: supervised Salary / Hourly Rate Duties: Start: End: Name of Phone Supervisor Number: Next Employer Employer Period of Employment Name: Hire: Company Address: Zip City: State: Code: Your Number of people you Title: supervised Salary / Hourly Rate Duties: Start: End: Name of Phone Supervisor Number: Career Planning
Last 4 September 2010 Full Name: of Soc. March 2011
In an essay format, please answer the following questions. Please be neat, check spelling and punctuations. Please print What is your “personal” five year plan?
What is your “professional” five year plan?
How can Women on the Way Up, Inc. help you meet your goals? Thank you for submitting your application to Women on the Way Up, Inc. for the upcoming semester. Your application will be reviewed by the WWU Selection committee. You will receive notification by mail if your application has been selected.
Application Review & Selection Process
Semester September 2010 April 2011 Semester
Application deadline August 1 March 1
Committee Review August 5 March 5
Committee Selection August 7 March 7
Notifications mailed August 10 March 10
Fees Due September 15 April 15
If you have any questions regarding the application process, please contact us at [email protected] or call 206-202-1158.
Mailing Address: Women on the Way Up, Inc. P.O. Box 7082 Gaithersburg, MD 20877