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[Hidden] Program Info

Has the Application Template been reviewed and approved?

YesNo

Application Deadline Passed?

Application Deadline PassedApplication Deadline NOT Passed Yet

This will be checked if the Application Template has NOT been reviewed and/or the application deadline has already passed.

Do not allow applicant to proceed

Course Web ID

Record Type ID

Landing Page Content

[Hidden] Program Eligibility Route Out or Not

Eligibility Questions

Driver's License Redirect YESDriver's License Redirect NOResidency Redirect YESResidency Redirect NOHS Diploma/GED Redirect YESHS Diploma/GED Redirect NODA Video Redirect YESDA Video Redirect NO

Residency Locations

[Hidden Set] Program Specific Questions

Program Specific Questions

CCSF	CMA	Computer Experience
Criminal Background Check	Dislocated Worker Status	Drug Screen
Employment Details	Enjoy Working with Hands	Externship
Foster Care	GA/PAES	Household
HSA	Immunization	Injection Training
Jobs Applied to Recently	Jobs Now	Kaiser Employment
Language - Professional Proficiency	MA Experience	Nursing License
Nursing School	OEWD	Office Experience
Previous Healthcare Experience	Previous Industry/Occupation	Program Referral
Remote Learning	Salesforce Experience	School Details
Selective Service	SFSU	Skilled Trades Careers Interested In
SNAP Benefits	Travel	UCSF Employment
Underemployment Info

Program Contact Email

Notification Email Subject Line to Applicant

Notification Email Content to Applicant

Application Deadline

This application is currently under construction. We apologize for any inconvenience.

If you have any questions or concerns, please reach out to info@jvs.org.

To learn more about the different programs at JVS, please check out our many skills training courses here.

Application Deadline:

The application deadline for this Program has passed.

If you have any questions or concerns, please reach out to info@jvs.org.

To learn more about the different programs at JVS, please check out our many skills training courses here.

Program

Program Name

Program Name Calculated

Program

Automotive_Pre_ApprenticeshipBookkeeping_Training_and_Paid_Internship_ProgramBridge_CourseCivil_Service_Trades_Pre_ApprenticeshipCVHN_MA_CertCybersecurity_AdvancementData_Analyst_TrainingDental_Assistant_TrainingIE_Apprenticeship_Exam_PrepIE_GIS_IntIE_Trades_JobsIE_InternshipIT_SupportJob_Search_AcceleratorKaiser_MA_CertificationLA_Dental_Assistant_TrainingMedical_Administrative_AssistantMedical_Assistant_CertificateMedical_Assistant_RefresherSac_Medical_Assistant_CertificateSalesforce_AdministratorSF_Nursing_RefresherSkilled_Trades_Internships_in_the_Water_SectorTech_Sales_TrainingUCD_Medical_Administrative_AssistantUCSD_SPTUCSF_Practice_Coordinator

Application Deadline:

Application Information

Jewish Vocational Service (“JVS”) values your privacy. JVS is a 501(c)(3) nonprofit organization that transforms lives by helping people build skills and find jobs to achieve self-sufficiency.

By filling out this application, you agree that your personal information will be handled as described in our Privacy Policy (this link will open in a new window).

All fields in this application marked with an asterisk (*) are required.

If you are re-submitting an application to the same program, your newest application will replace your previous application submitted into our system if the previous application has not been reviewed yet.

If you are not ready to submit yet, please save the application so you can resume at a later time (the Save and Resume option can be found on the top or bottom of the page). If you save your application, please remember to go back and submit your application before the deadline.

General Info

First Name

Middle Initial

Last Name

If you go by another name, please provide it here:

Date of Birth (MM/DD/YYYY)

Date of birth is a unique identifier for clients and helps determine what additional internal and external resources might be available to them. If you have any questions about how JVS uses DOB information, please reach out to the Director of Client Services at druggles@jvs.org.

Contact Info

Please enter in your full street address and select from the available options.
Once selected, your full address will appear below.

e.g., 548 Market Street

City

e.g., San Francisco

State

e.g., CA

Country

Zip Code

e.g., 94104

Full Address:

If you are unable to find your address in the search bar above, please clear your selection by pressing the "x" and check this box

Please provide your address below.

Street Address

e.g., 548 Market Street

City

e.g., San Francisco

State

e.g., CA

Zip Code

e.g., 94104

Phone

e.g., (415) 391-3600

I agree to receive text messages at the phone number provided above. I understand that I can reply STOP any time to opt out. Message and data rates may apply

Email

e.g., info@jvs.org

You will be added to JVS's email list where we will share upcoming events, resources, and more. JVS respects your privacy. We do not share, trade, or sell your personal information.

No, please do not add me.

Please enter your address above before proceeding.

Do not allow to proceed if Address is NULL

Demographic Information

What is your gender identity? (Please select all that apply.)

ManWomanGenderqueer, transgender, non-binary, gender fluid, genderless, gender-free, and/or gender nonconformingAn identity not listedPrefer not to disclose

Please specify:

[Hidden] Calculation for SaFo

[FormattedGenderIDSelectionSaFo] - HIDDEN FIELD

[GenderIDCalc] - HIDDEN FIELD

Please provide your gender pronoun(s):

e.g., he/him, she/her, or she/they

Please select your sexual orientation (choose all that apply):

Asexual	Bisexual	Gay
Lesbian	Pansexual	Queer
Questioning or unsure	Same-gender loving	Straight (heterosexual)
An identity not listed	Prefer not to disclose

Please specify:

[Hidden] Calculation for SaFo

[FormattedSOSelectionSaFo] - HIDDEN FIELD

[SOCalc] - HIDDEN FIELD

Demographic Information

Which of the following options best describes your race/ethnicity? (Please select all that apply. The choices provided are predominately based on the American Census. If an option is not listed, you will have an opportunity to be more specific)

American Indian or Alaska NativeAsianBlack or African AmericanHispanic, Latino, or Spanish OriginMiddle Eastern or North AfricanNative Hawaiian or Pacific IslanderWhiteNot ListedPrefer not to answer

If not listed, please specify:

For American Indian or Alaska Native, please select all that apply:

AztecBlackfeet TribeMayanNative Village of Barrow Inupiat Traditional GovernmentNavajo NationNome Eskimo CommunityNot Listed

If not listed, please specify:

For Asian, please select all that apply:

Asian IndianCambodianChineseFilipinoHmongJapaneseKoreanPakistaniVietnameseNot Listed

If not listed, please specify:

For Black or African American, please select all that apply:

African AmericanEthiopianHaitianJamaicanNigerianSomaliNot Listed

If not listed, please specify:

For Hispanic, Latino, or Spanish Origin, please select all that apply:

Colombian Cuban Dominican Ecuadorian Guatemalan Mexican, Mexican American, or ChicanoPuerto RicanSalvadoran Spaniard Not Listed

If not listed, please specify:

For Middle Eastern or North African, please select all that apply:

ArabAzerbaijaniEgyptianKurdLebanesePersianTurkNot Listed

If not listed, please specify:

For Native Hawaiian or Pacific Islander, please select all that apply:

ChamorroFijianMarshalleseNative HawaiianSamoanTonganNot Listed

If not listed, please specify:

For White, please select all that apply:

EnglishGermanIrishItalianNot Listed

If not listed, please specify:

[FormattedRaceSelectionSaFo] - HIDDEN FIELD

[RaceCalculation] - HIDDEN FIELD

[NotListedAmIndAlsNatFormatted] - HIDDEN FIELD

[NotListedAsianFormatted] - HIDDEN FIELD

[NotListedBlackFormatted] - HIDDEN FIELD

[NotListedHispanicLatinoFormatted] - HIDDEN FIELD

[NotListedMENAFormatted] - HIDDEN FIELD

[NotListedNatHIPacIslFormatted] - HIDDEN FIELD

[NotListedWhiteFormatted] - HIDDEN FIELD

[ClientSelectionEthnicity] - HIDDEN FIELD

[EthnicityFormatted] - HIDDEN FIELD

[EthnicityCalculation] - HIDDEN FIELD

Demographic Information

In what country were you born?

If not listed, please specify:

Per the U.S. Census Bureau, Veterans are individuals who have served (even for a short time), but are not currently serving, on active duty in the U.S. Army, Navy, Air Force, Marine Corps, or the Coast Guard, or who served in the U.S. Merchant Marine during World War II.

Are you a Veteran?

YesNo

Referral Information

How did you first hear about JVS?

If not listed, please specify:

If you have someone at JVS you have been in contact with, please provide the name here:

How did you first hear about the program you are applying for today?

If not listed, please specify:

Eligibility

As part of this application process, JVS will ask you to confirm some of the information you provided here at a later time to make sure that you meet program eligibility requirements.

Will you be 18 years or older at the start of the program?

YesNo

Per the U.S. Citizenship and Immigration Services, U.S. employers must check to make sure all employees, regardless of citizenship or national origin, are authorized to work in the United States. For details on acceptable documentation that provide proof of authorization to work in the U.S., please see the Form I-9 Acceptable Documents page (link will open in new window).

Are you authorized to work in the U.S.? You will need to provide proof of authorization if accepted into this program.

YesNo

Will you be able to provide valid, non-expired identity documents (can be driver's license, passport, permanent resident card, social security card, etc.)?

YesNo

This program requires a significant amount of time commitment. Would you be able to make the time commitment?

YesNo

Please explain why you would not be able to make the time commitment:

The health and safety of our JVS community remain at the center of our work. Proof of COVID-19 vaccinations will now be required for all program participants. Check out our Frequently Asked Question document (this link will open in a new window) for more information and resources on how to get your free vaccination.

Have you received full vaccination against COVID 19?

YesNo

Do you plan to receive the COVID-19 vaccine prior to the start date of the program?

YesNo

Do you have a High School Diploma or GED or will be able to obtain one before the start of this program?

YesNo

Do you have a High School Diploma or GED or will be able to obtain one before the start of this program?

YesNo

What is the highest level of education you will have completed by the start of this program?

If not listed, please specify:

Did you or will you earn this degree in the United States?

YesNo

Do you have a valid non-expired CA Driver's License?

YesNo

If no driver's license, please explain your situation and explain whether or not you will be able to obtain one before the program begins:

Do you have a valid non-expired CA Driver's License?

YesNo

If no driver's license, please explain your situation and explain whether or not you will be able to obtain one before the program begins:

Are you a resident of:

YesNo

Are you a resident of:

YesNo

Did you watch the videos on the JVS website outlining the position of a Dental Assistant?

YesNo

Did you watch the videos on the JVS website outlining the position of a Dental Assistant?

YesNo

Eligibility

This program's partners request you complete a criminal background check to enroll in this program. Due to the nature of this program, you may be asked for follow up information or screening to re-confirm eligibility. As all circumstances are unique, JVS reviews the answers on a case-by-case basis.

Will you be able to pass a criminal background check?

YesNo

Please explain and list any prior criminal convictions:

This program's partners request you complete a drug screening to enroll in this program. Due to the nature of this program, you may be asked for follow up information or screening to re-confirm eligibility. As all circumstances are unique, JVS reviews the answers on a case-by-case basis.

Will you be able to pass a drug screen?

YesNo

Please explain why you would not be able to pass a drug screen test:

In order to be eligible to enroll in this program, all people assigned male at birth born on or after January 1st, 1960 must present documentation showing compliance with the Selective Service registration requirements.

If you are not sure if you are required to register or what Selective Service is, please check out this FAQ regarding the U.S. Selective Service System.

You can also verify your registration here.

Are you registered for selective service?

YesNoSelective Service does not apply to me

If you do not meet the eligibility requirements for this program, would you still like to be considered for another program at JVS you may be eligible for? We will reach out to you by email if you are eligible for another program.

Yes, please reach out to me No, I do not want to be contacted

If you have any questions or concerns, please let us know here:

If checked, do not allow to proceed

Does not meet eligibility requirement(s)

Language(s)

What is your primary language?

If not listed, please specify:

Do you have professional proficiency in reading, writing, and speaking in another language?

YesNo

If so, please select all that apply:

To select multiple items in the list, hold down the Ctrl (PC) or Command (Mac) key. Then click on your desired items to select. All of the items you have selected should be highlighted with a different-colored background.

If not listed, please specify

Participant Services Support

The following questions are for us to assess what services you might need and help us tailor our job training support.

In order to support you in your journey with JVS, it is helpful to know what other organizations you are receiving support from and/or the support you may be receiving.

Do you have access to a personal computer/technology (ex: laptop, smartphone, etc.)?

Yes, I have access to a personal computer/technologyNo, I am reliant on public computers

What computer/technology do you have access to? (Please select all that apply)

I have a laptopI have a desktopI have stable Internet connection at homeI have access to a smartphoneI have access to a webcam

[Hidden] Access to computer concatenated field

Are you currently enrolled in Jobs NOW!?

YesNo

Are you receiving general assistance from CalWORKS and/or Personal Assisted Employment Services (PAES)?

General assistance through CalWORKSPersonal Assisted Employment Services (PAES)BothNeither

Have you ever received services from the Department of Rehabilitation (DoR)?

YesNo

Have you ever participated in a Human Services Agency (HSA) program before?

YesNoNot sure

Which HSA program did you participate in?

Are you currently accessing any resources from another organization? (For instance, recovery resources, disability, unemployment insurance, housing assistance, workers’ compensation, etc.)?

YesNo

If so, please list the name of the organization(s) and the type of public benefit(s) you are receiving:

JVS is committed to supporting participants during their time in the program. We understand that things come up that may hinder your ability to be successful in training or your job search, including housing, utility bills, professional clothing, transportation, and access to food. As part of this, we have funding available to support actively enrolled participants with unexpected expenses or bills. We may also refer you to an external organization for additional support.

Will you need financial support during the course of this program?

YesNoNot sure

This program requires that you travel to class, or to the work-based learning site, or to both. Do you have reliable transportation to get to those locations on time?

YesNo

Please explain your transportation method (personal car, bus, BART, muni, etc.)

Were you ever in foster care?

Yes, I was previously in foster care and currently no longer in foster care.

Yes, I am currently in foster care.

No, I was never in foster care.

To be successful in an interview or in this program, will you need a reasonable accommodation? *

Some examples of reasonable accommodations we have provided in the past are:

Large text documents
Dragon Naturally Speaking software
Zoom Text software
Sign Language Video Relay Service Closed captions
Video and audio recordings

YesNo

Please explain:

Participant Services Support

JVS wants to understand more about what a living wage means to you given your family composition, so that we can better tailor our services and provide applicable resources for your needs.

How many people are in your household, including yourself, your dependents, and anyone else who lives with you?

The term “family size,” as defined by The Office of Economic and Workforce Development (OEWD) means two or more person related by blood, marriage, or decree of court who are living in a single residence and are included in one or more of the following categories:

1. A married couple and dependent children
2. A parent or guardian and dependent children, or
3. A married couple

What is your family size, including yourself?

Please estimate your total family income for the past 6 months:

- Income to Include: Gross wages and salary, Government retirement payments, Pensions, Social Security payments, Net rents, Alimony, WIA OJT wages.

-Income NOT to include: Public assistance, food stamps, child support, inheritance, one-time awards or unemployment insurance benefits.

Please enter a whole number

Do you have children under the age of 18 or any other adult dependents in your family you must care for?

YesNoA dependent is someone under the age of 18 who lives with you or a person who you financially support.

How many dependents do you have?

Do you have reliable and consistent help with the care of your children or adult dependent(s)?

YesNo

Please describe your plans for securing childcare or care for your dependent(s) throughout the duration of this program:

Are you currently receiving SNAP benefits (aka food stamps)?

YesNo

What is the current estimated monthly income for your household? Please note that your monthly income does not impact your eligibility to be enrolled in this program, but rather helps us in assessing your eligibility for receiving additional benefits.

Education

School Info

Are you currently enrolled in school or a training program?

YesNo

How many hours per week are you currently attending school?

School Details

Please provide the name of the school or training program you are currently enrolled in:

Did you enroll with a different name than the one you provided in this application?

YesNo

What name did you use to enroll?

Are you currently taking any classes, courses, or trainings that relate to this program?

YesNo

Please list the specific classes, courses, or trainings that relate to this program:

Nursing School Details

Is this school or training program a Nursing School or a Nursing Program?

YesNo

Have you ever attended a Nursing School or Nursing Program?

YesNo

Where is the school or program located? Please provide the city and state.

Ex: San Francisco, CA

How long is the Nursing School or Program?

Ex: 2 years, 6 months, or 5 semesters

Please provide the name of the Nursing School or Program:

How long was the Nursing School or Program?

Ex: 2 years, 6 months, or 5 semesters

Did you enroll with a different name than the one you provided in this application?

YesNo

What name did you use to enroll?

Did you graduate from the program?

YesNo

What year did you graduate from the Nursing Program?

e.g. 1995

Did you obtain a nursing certificate/diploma?

YesNo

Do you have a copy of your nursing diploma ready to upload with this application?

YesNo

Please upload a copy of your nursing certificate/diploma:

File size limit 10MB

Please send a copy of your nursing certificate/diploma to the following email:

City College of San Francisco Details

Were you previously enrolled as a student at the City College of San Francisco (CCSF)?

YesNo

When were you enrolled as a student?

Ex: Fall 2012 - Summer 2015, or 8/2012 - 6/2015

Were you enrolled at CCSF with a different name than the one you provided in this application?

YesNo

Please provide the name you used to enroll in CCSF:

Did you graduate?

YesNo

What year did you graduate?

San Francisco State University Details

Were you previously enrolled as a student at San Francisco State University (SFSU)?

YesNo

When were you enrolled as a student?

Ex: Fall 2012 - Summer 2015, or 8/2012 - 6/2015

Were you enrolled at SFSU with a different name than the one you provided in this application?

YesNo

Please provide the name you used to enroll in SFSU:

Did you graduate?

YesNo

What year did you graduate?

Hidden Fields for graduation year

Nursing Grad Info

CCSF Grad Info

SFSU Grad Info

Concatenated Grad Year Info

Year of graduation

Hidden fields for "Name used to enroll as student" field

Current School Enrolled Name

Nursing School Enrolled Name

CCSF Enrolled Name

SFSU Enrolled Name

Concatenated Names

Name used to enroll as student

Employment Information

As a workforce development organization, JVS gathers participants’ current and prior employment information so it can better tailor its services and resources to their participants.

Are you currently employed (including part-time, contract work, etc.)?

YesNo

Have you ever worked for Kaiser Permanente?

Yes, I am a current employeeYes, I am a former employeeNo, I have never worked for Kaiser Permanente

What is your Kaiser Employee ID?

Have you ever worked for the University of California San Francisco (UCSF)?

Yes, I am a current employeeYes, I am a former employeeNo, I have never worked for UCSF

How long have you worked for UCSF?

How long did you work for UCSF previously?

If you are currently working at more than one job, please answer the following questions based on your primary job. The primary job should be the employment with the most hours worked per week

What type of employment do you have?

Full-time regularFull-time temporary/contractPart-time regularPart-time temporary/contract

How many hours per week are you currently working? If the number varies from week to week, please enter an estimated average hours worked per week.

Please enter in a number between 0.01 - 168.

Are you self-employed?

YesNo

Who is your current employer?

Have you talked to your employer about attending this program?

YesNo

What is your current job title?

Please describe your current job role:

Do you feel like you are underemployed (working fewer hours due to economic reasons or being paid less than is commensurate with your skills and experience)?

YesNo

Do any of these underemployed reasons apply to you? (Please select all that apply)

I'm currently working, but paid less than in the pastI'm currently working part-time, but I would like to work full timeI'm currently working, but my pay is not commensurate with my educationNone of these apply to me

If none of the options apply, please only select "None of these apply to me"

Underemployed Calculation if Error

Do not allow to proceed if other choices are selected with "None of these apply to me"

[Hidden] Underemployed Reasons Formatted Data for SaFo

How many months have you been underemployed? (Please round up)

e.g. If underemployed for 6.5 months, please enter 7

How many months have you been unemployed? (Please round up)

e.g. If unemployed for 6.5 months, please enter 7

Are you a spouse of a member of the Armed Forces on active duty?

YesNo

Please select the status that best describes your current unemployment situation:

Which of the following describes why you are not currently working?

Laid off or dislocated from last jobTerminated from last jobQuit or left job last jobI have never workedI am retiredNone of the above

What is your current unemployment benefits status?

Please explain your unemployment situation and provide any barriers that are preventing you from obtaining a job:

Experience

Do you have any recent experience that relate to this program?

YesNo

Please describe your recent experience:

Do you have any personal experience(s) you would like to add (ex: volunteer experience)?

YesNo

Please describe your personal experience(s) and how they could apply to this program:

Computer Experience

Please rate your confidence using a computer (Mac or PC):

Not confidentSomewhat confidentConfidentVery confident

Do you have an intermediate or advanced understanding of any of the following computer programs? (Select all that apply)

Adobe Creative Suite	Bookkeeping tools (QuickBooks, etc.)
Google Classroom	Google Drive (Google Docs, Sheets, Slides, etc.)
Google Hangouts	Microsoft Access
Microsoft Excel	Microsoft Outlook
Microsoft PowerPoint	Microsoft Word
Salesforce	Websites
Zoom	Not Listed
I am not familiar with any of these programs or any additional computer programs

Please list the technology programs and tools you have experience with that are not listed above:

If "I am not familiar with any of these programs or any additional computer programs" is selected, no other option(s) should be selected. Please review.

[Hidden ] Computer experience formatted data for SaFo

Do not allow to proceed if "None" is selected with additional options.

Remote Learning Experience

Please identify your level of experience with online and/or remote learning:

Very experienced (e.g. I took an online class)Somewhat experienced (e.g. I have done YouTube tutorials)No experience (e.g. I have only done in-person learning)

Please explain your remote learning experience:

Salesforce Experience

How much paid or volunteer experience do you have using Salesforce in an Administrator capacity? Note: experience is not required.

1-6 months of experience7-12 months of experienceMore than a year of experienceI do not have any Salesforce Admin experience

Do you have experience as a Salesforce user in any capacity (ex: self-study or non-admin user)?

YesNo

Please describe your experience as a Salesforce user (can be as administrator, through self-study, non-admin user, etc.).

Do you have any additional Customer Relationship Management (CRM) software experience?

YesNo

Please describe your CRM experience:

Office Experience

Do you have experience in an office setting?

Yes, I have worked in an office in a full-time role.Yes, I have worked in an office in a part-time role.Yes, I have volunteered in an office.No, I have never worked nor volunteered in an office setting.

Please describe your experience in an office setting:

Externship Experience

Have you completed any externships?

YesNo

Please describe any externship(s) you have completed that relate to this program:

Medical Assistant Experience

Do you have any experience as a Medical Assistant (MA)?

YesNo

Please describe your MA experience:

Previous Healthcare Experience

Do you have any previous healthcare experience?

YesNo

Please describe your healthcare experience and provide details regarding dates, hours, job role, etc.:

Injection Training Experience

Do you have specific injection training and/or experience?

YesNo

Please describe your injection training or experience:

Licenses and Certifications

Do you have any active professional certifications or licenses that relate to this program?

YesNo

Please provide the following information for your most recent certification(s) and/or license(s). You can provide up to 2 certifications/licenses in detail. If you have additional professional certifications/licenses, you will have an option to list them below.

Certification 1

Type of certification or license

Issue Date:

Please enter in the following format: MM/DD/YYYY

Does this certification or license have an expiration date?

YesNo

Please provide the expiration date:

Please enter in the following format: MM/DD/YYYY

Was this certification or license issued in the U.S.?

YesNo

Do you have a copy of the certification ready to upload to this application?

YesNo

Please upload a copy of your certification or license:

File size limit 10MB

You can send a copy of your certification to the following email at a later time:

Do you have an additional active professional certification or license that relates to this program that you would like to add?

YesNo

Certification 2

Type of certification or license

Issue Date:

Please enter in the following format: MM/DD/YYYY

Does this certification or license have an expiration date?

YesNo

Please provide the expiration date:

Please enter in the following format: MM/DD/YYYY

Was this certification or license issued in the U.S.?

YesNo

Do you have a copy of the certification ready to upload to this application?

YesNo

Please upload a copy of your certification or license:

File size limit 5MB

You can send a copy of your certification to the following email at a later time:

Nursing License

Are any of the certifications or licenses entered above an active vocational nursing and/or registered nursing license (LVN/RN)?

Yes, Certification 1 is a nursing licenseYes, Certification 2 is a nursing licenseNo, neither are a nursing license, but I have an inactive nursing licenseNo, I have never obtained a nursing license

Please provide the nursing license number:

Is this a restricted license?

YesNo

When did the license expire?

Please enter in the following format: MM/DD/YYYY

Are you in the process of updating your license?

YesNo

Please provide the anticipated date of license update:

You can enter an exact date, e.g., "12/01/2022" or a relative date, e.g. "Within the next 3 months."

Was this license ever restricted?

YesNo

Do you have an active vocational nursing and/or registered nursing license (LVN/RN)?

Yes, I have an active licenseNo, I have an inactive licenseI have never obtained a nursing license

Please provide the nursing license number:

Active Nursing License

What type of nursing license do you currently have?

When does the license expire?

Please enter in the following format: MM/DD/YYYY

Please upload an image of your nursing license card:

File size limit 10MB

Is this a restricted license?

YesNo

Inactive Nursing License

What type of nursing license did you have previously?

When did the license expire?

Please enter in the following format: MM/DD/YYYY

Are you in the process of updating your license?

YesNo

Please provide the anticipated date of license update:

You can enter an exact date, e.g., "12/01/2022" or a relative date, e.g. "Within the next 3 months."

Was this license ever restricted?

YesNo

Clinical Medical Assistant Certificate

Are any of the above certifications a Clinical Medical Assistant Certificate (CMA)?

Yes, Certification 1 is a CMAYes, Certification 2 is a CMANo, none of the certifications entered above are a CMA

Do you have a Clinical Medical Assistant Certificate (CMA)?

YesNo

Do you have a copy of the CMA ready to upload to this application?

YesNo

Please upload a copy of your certificate:

File size limit 10MB

You can send a copy of your CMA to the following email at a later time:

Additional Certifications and Licenses

Do you have any additional professional certifications and/or licenses (does not need to relate to this program)?

YesNo

Please list additional professional certifications/licenses you have:

Immunization Info

This Dental Assistant Training Program requires that you meet specific immunization requirements.

Details about the immunization requirements can be found here (this link will open in a new window).

This program requires that you meet specific immunization requirements.

Details about the immunization requirements can be found here (this link will open in a new window).

This Medical Assistant Refresher Program requires that you meet specific immunization requirements.

Details about the immunization requirements can be found here (this link will open in a new window).

This program requires that you meet specific immunization requirements.

Will you be able to provide your updated immunization records?

YesNo

Please explain why you will not be able to provide your updated immunization records:

Career Goal and Employer Alignment

What industry were you working in previously?

What was your occupational role?

If not listed, please specify:

What jobs have you applied to recently?

What skilled trades careers in the Transit/Automotive Industry do you think you might be interested in?

Automotive TechnicianMachinistMechanicNot Listed

If not listed, please elaborate on the specific skilled trade roles you are interested in:

SkilledTradesText

Skilled Trades Careers Interested In

Please explain your interest with a career working with your hands:

You indicated earlier that you are currently attending school and/or currently working. Do you plan to reduce your school and/or work hours to attend this program?

YesNoMaybe

How do you plan to reduce your workload to make room for this program?

What type of job(s) are you looking for? Please list your desired industry and what kind of job you’d like in that industry. Alternatively, you could tell us about your overall career goals.

Please write at least 3-4 sentences describing what excites you about this program and how your unique skills and/or experiences will help you be successful in this program.

End of Application

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