Screening Application for participation in Chicago Career Tech

Note

The pilot group (May2010 to October 2010) application process is closed. Screening applications are now being accepted for Group 2, scheduled for October 2010 through March 2011. Chicago Career Tech will send applicants an email to verify your interest in the program mid-summer 2010.

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Applicant Requirements

Resident of the City of Chicago*
High school diploma, GED or higher level of education*
Unemployed, with previous annual income of $25,000 to $75,000*
Collecting unemployment insurance in Illinois* OR have exhausted unemployment insurance benefits in Illinois*
Able to pass criminal background check and drug test
Available for, and committed to the six days/week, six month program

*Proof required for those selected to complete follow up application.

Filling Out This Application

The application must be fully completed
* = required field
When entry is complete, press the “Submit” button at the bottom of the page
If there are errors on the form, error messages will appear at the top of the page in red. Please correct all entry errors (highlighted in red throughout the page) and press the “Submit” button again at the bottom of the page

What's next?

Upon successful submission of this application, an email, with a copy of the completed application form, will be sent to the email address you list below.
This is an initial, screening application. A follow up application requiring proof of eligibility will be e-mailed to those selected to continue in the application process. Please visit the website for updated information on the timeline.

Upon selection to complete the follow up application, you will be required to submit

Proof of City of Chicago residency (One copy of the following: driver’s license, state identification card, most recent utility or credit card bill)
Proof of legal right to work in the US (One copy of the following: US birth certificate, US passport, or certificate of US citizenship)
Resume (no more than two pages)
Proof of Illinois unemployment insurance benefits or proof of exhausted Illinois unemployment insurance benefits (Copy of IDES certification letter and most recent claim statement)
Most recent paycheck stub confirming previous annual salary of $25,000-$75,000
Official high school or college transcript, or copy of GED certificate

Screening Application Form

Name

First Name: *

Middle Name:

Last Name: *

Address

Home Address: *

Home Address 2:

City: *

State: *

Zip Code: *

Zip code must be in the 606_ _ area

Contact Information

Email Address: *

Phone Number: *

Citizenship

Do you have a legal right to work in the US?: *

Yes

Education

Check all that apply, and list school name

High School Diploma or GED: *

Yes

High School Name & Location: *

College - Associates Degree:

Yes

Associates Degree School Name, Location & Major:

College - Bachelors Degree:

Yes

Bachelors Degree School Name, Location & Major:

College - Graduate Degree:

Yes

Graduate Degree School Name, Location & Major:

Other:

Please describe; include school name & major/certificate

Work Status

Select One: *

Terminated, laid off or have received notice of layoff

Previously self employed, but unemployed as a result of general economic conditions

Dislocated worker - working but still receiving unemployment insurance compensation

Displaced homemaker - unemployed, under-employed, or dependent on laid-off family member

Other

If Other, Please Specify:

Are you receiving unemployment insurance?: *

Yes

If Yes, how much is your weekly amount?: * $

Enter $0 if not receiving unemployment benefits.

If No, why are you not receiving unemployment benefits?:

Work Experience

Date Unemployed: *

Unemployment date must be prior to today’s date. If received notice of layoff, can describe in the "Other Work Experience" box below)

List Previous 2 Employers
If currently working, but under-employed, place current employer information in "Employer 1" section.

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Employer 1

Employer Name: *

Address: *

City, State, Zip: *

Start Date: *

End Date:

Salary (enter 1): *

Hourly Rate

Annual Salary

Salary Amount: * $

Position: *

Description of Work: *

Reason for Leaving Job: *

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Employer 2

Employer Name:

Address:

City, State, Zip:

Start Date:

End Date:

Salary (enter 1):

Hourly Rate

Annual Salary

Salary Amount: $

Position:

Description of Work:

Reason for Leaving Job:

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Other Work Experience:

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Screening Application for participation in Chicago Career Tech

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Screening Application Form

Employer 1

Employer 2