Telecom/Cabling Boot Camp informational session attended and certificate attached CALL (262) TO SCHEDULE TODAY!

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2 Tom/Cabing Training Training: Training wi tak pa at Gatway Thnia Cog s SC Johnson imet Cntr at 0 Rnaissan Bvd in Sturtvant bginning Monday, January 9, 01, and nding Friday, Apri 0, 01. Cass runs Monday Friday 7:0am 4:0pm. Fr parking is avaiab in th ot in front of th ampus. Th imet Cntr is on th ity bus in. Boot amp osts wi b paid for by a grant from SC Johnson a Famiy Company. Tom/Cabing Boot Camp Chkist Mak sur that you ompt a stps and hav th appropriat doumntation attahd whn submitting your appiation. Tom/Cabing Boot Camp informationa sssion attndd and rtifiat attahd CALL () -541 TO SCHEDULE TODAY! Tak Kytrain Math Pr-tst (s pag 4 for workshop dats). GTC s Aupar assssmnt tst rsuts attahd (stps on pag ) Work Appiation omptd (pag 7 & ) Printd opy of rsum attahd Boot Camp Information Survy omptd and attahd aong with supporting doumntation (pag 5) Southast Workfor Dvopmnt Board xptations worksht omptd and attahd (wi riv at information sssion) Essay attahd (optiona); No mor than 00 words

3 Tom/Cabing Boot Camp Appiation Pross QUALIFICATIONS Minimum Quaifiations: To b onsidrd for th Tom/Cabing Boot Camp appiants must, at a minimum, mt th foowing ritria: 1. B a rsidnt of Rain, Knosha, or Waworth County. B at ast 1 yars of ag. Turn in omptd appiation by January 5, 01 bfor 5:00pm. S ovr to dtrmin whr you an rturn your omptd appiation. APPLICATION PROCESS STEP 1 Appiations wi b aptd unti 5:00pm Dmbr 15, 017. To b onsidrd a ompt appiation, th foowing must b inudd: 1) Origina rtifiat of attndan for th Tom/Cabing Boot Camp information sssion: This sssion xpors tom as a arr, and xpains th assroom xptations and mpoymnt goas of th boot amp (rtifiat providd at sssion). Ca () -541 to shdu your sssion. ) Comptd SEWDB Work Appiation (attahd) ) Papr opy of rsum 4) Rviw and signd SEWDB xptations worksht (providd at information sssions) 5) Comptd Boot Camp Information Survy aong with supporting doumntation ) Aftr taking th Kytrain Math pr-tst and soring at ast a 4, th Gatway Aupar shoud b shdud and takn. Attah a opy of th Aupar tst rsuts to your appiation. 7) Optiona (but rommndd) - A typd or printd writtn ssay of no mor than 00 words xpaining why you shoud b providd th opportunity to partiipat in this program Inompt or at appiations wi not b onsidrd! STEP A omptd appiations wi b rviwd and std appiants wi b invitd to an intrviw to assss thir intrst and quaifiations. STEP Std and quaifid appiants wi b offrd an opportunity to partiipat in th program. STEP 4 Std partiipants must attnd a fu-day rgistration/nromnt sssion to ompt rquird Southast Workfor Dvopmnt Board paprwork. Notifiation of Stion: Ony appiants who hav bn std wi b notifid.

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5 Boot Camp Information Survy Unmpoymnt Eigibiity Within th ast thr yars hav you otd Unmpoymnt Insuran? Ys No If so, pas submit 1099-G, ttr of igibiity from th Unmpoymnt Insuran Division. If you do not hav a 1099-G any rnt orrspondn from Unmpoymnt wi suffi. During 015, 01, or 017 did you os your job through no faut of your own? Ys No Vtran s Status Ar you a miitary vtran with at ast 10 days of ativ srvi, a spous of a vtran, or hid of a vtran kid in th in of duty? Ys No If you answrd Ys, attah a opy of your DD-14. Inom Pas stat your inom for th ast yar (from this dat to 1 yar ago) do not inud unmpoymnt. $ Tom/Cabing Saary Exptations Aftr doing som Intrnt rsarh on Tom/Cabing Instar saary rangs, what is a wag typiay arnd by an ntry-v Tom/Cabing Instar? (possib sour: $ an hour. Print th supporting pag and attah to th appiation. Th minimum saary that I am wiing to apt as a Tom/Cabing Instar is $ an hour. Commut Distan How many mis, on-way, ar you wiing to ommut for a job as a Tom/Cabing Instar? mis How did you find out about this boot amp? (giv spifi sour, wbsit, t ) Nam: Dat: 5

6 ma r k. mk u a i n o u n t y. o m

7 WORK APPLICATION Company Nam: Tom/Cabing Instar Boot Camp IV Dat: PLEASE PRINT OR TYPE ALL USE ADDITIONAL PAGES IF NECESSARY INFORMATION Prsona information you provid may b usd ony for dtrmining your quaifiations rativ to this position. Last Nam First Nam Midd Nam Appiation for Position of: Dat Avaiab Prsnt Addrss (numbr, strt, ity, stat, zip od) Hom Phon Maiing Addrss (if diffrnt from abov)(numbr, strt, ity, stat, zip od) C Phon What hours ar you NOT avaiab to work? AM PM Typs of Empoymnt Prfrrd (Chk mor than on box if dsird) What days ar you NOT avaiab to work? Rguar (Fu Tim) Rguar (Part Tim) Monday Tusday Wdnsday Sunday Tmporary (Fu Tim) Tmporary (Part Tim) Thursday Friday Saturday Unti: Unti: Do you hav ass to a ar? Ys No Do you hav a vaid drivr s ins? Ys No Ar you ovr ag 1? Ys No Ar you a U.S. Citizn, or do you hav an ntry prmit whih aows you to work? Ys No Hav you bn onvitd of a fony? If ys pas attah a writtn xpanation Ys No EDUCATION AND TRAINING Chk th box nxt to th highst grad or yar omptd in shoo: Do you hav a High Shoo Dipoma or GED Equivany? Ys No Yar attaind: Nam and Loation of High Shoo Training Byond High Shoo (Cog or Univrsity, Nursing, Businss Cog, or othr shoos you hav attndd.) Undr rdits arnd indiat Q for Quartr Hours and S for Smstr Hours. Dats Attndd Nam and Loation From To Chk th box nxt to th numbr of yars in Cog or Univrsity: Crdits Earnd Major Fid GPA/Bas Dgr (and Yar) Confrrd Dsrib any duation or training you hav had whih is not ovrd abov, suh as voationa shoo, orrspondn ourss, srvi shoo shoos, in-srvi training, or vountr work whih you f is rvant to th job or jobs for whih you ar appying. Aso inud rvant inss or rtifiats. B spifi. List any organizations you bong to (or hav bongd to) and any job ratd honors or awards you hav rivd: WORK EXPERIENCE: Provid a ompt dsription. This information wi b usd to dtrmin your quaifiations. BE SPECIFIC. Start with your most 7

8 rnt job. BE CERTAIN TO INCLUDE SERVICE IN THE ARMED FORCES. For part-tim work, show th avrag numbr of hours pr month. Indiat any hangs in job tit undr sam mpoyr as a sparat position. Empoyr Kind of Businss Strt Addrss Your Tit Rason for Laving City, Stat, Zip Cod Your Dutis Nam of Suprvisor Tota Tim Empoyd: From (Month & Yar) Fu Tim To (Month & Yar) Part Tim Empoyr Kind of Businss Strt Addrss Chk on: Monthy Saary Bginning: $ Houry Saary Ending: $ Your Tit Rason for Laving City, Stat, Zip Cod Your Dutis Nam of Suprvisor Tota Tim Empoyd: From (Month & Yar) Fu Tim To (Month & Yar) Part Tim Empoyr Kind of Businss Strt Addrss Chk on: Monthy Saary Bginning: $ Houry Saary Ending: $ Your Tit Rason for Laving City, Stat, Zip Cod Your Dutis Nam of Suprvisor Tota Tim Empoyd: From (Month & Yar) Fu Tim To (Month & Yar) Part Tim Chk on: Monthy Saary Bginning: $ Houry Saary Ending: $ Empoyr Kind of Businss Strt Addrss Your Tit Rason for Laving City, Stat, Zip Cod Your Dutis Nam of Suprvisor Tota Tim Empoyd: From (Month & Yar) Fu Tim To (Month & Yar) Part Tim Chk on: Monthy Saary Bginning: $ Houry Saary Ending: $ May w ommuniat with your prsnt mpoyr? Ys No May w ommuniat with your past mpoyrs? Ys No PROFESSIONAL REFERENCES: (Pas ist thr businss rfrns who hav knowdg of your xprin and abiity.) Nam Businss Nam Tphon Nam Businss Nam Tphon Nam Businss Nam Tphon Signatur Dat Signd:

Form. Tick the boxes below to indicate your change(s) of circumstance and complete the relevant sections of this form

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