VetWORKS Program Interest Form

Date (required)

First Name (required)

Last Name (required)

Home Phone (required)

Cell Phone

Email (required)

City (required)

Veteran Status (required)

Active duty

Reserves

Separated from military within the last 4 years

Separated from military more than 4 years ago

Separation Date?

Highest rank when separated? (required)

Are you a campaign veteran? (required)

Yes

No

Are you at least the age of 21 or over? (required)

Yes

No

Do you have a service-connected disability? (required)

Yes

No

On SSDI or SSI? (required)

Yes

No

Employed? (required)

Yes

No

If you are not working, state your last date of employment

Occupation when working (required)

Housing Status (required)

Home Owner

Rent/Lease

Living with Friends/Relatives

Homeless/At Risk of Homeless

Select the one training that you are most interested in (required)

CompTIA A+

CompTIA N+

CompTIA Security+

MCSA Windows 7

Microsoft Office Specialist (MOS) Word

Microsoft Office Specialist (MOS) Excel

Availability? (required)

I am available anytime Mon - Fri from 9:00 - 5:00

I have limited availability Mon - Fri from 9:00 - 5:00

How many hours are you available to attend class each week? (required)

Less than 9 Hours

9 hours

12 Hours

24 hours

More than 24 hours

Describe your attitude? (required)

I am committed to completion of training

I will focus on training but if I get a job, I will need to drop out of training

Work experience (required)

I have IT experience

I have management experience

I have administrative/clerical experience

No work experience

Other experience

If you selected Other experience above, please describe?

Postsecondary education

Yes

No

If you are currently enrolled in a degree or training program, what is your expected graduating date?

How do you plan to advance your career with this training? (required)

Summarize your experience: (required)

Describe the job you want upon completion of training: (required)

Where did you hear/learn about Able-Disabled Advocacy's training and employment programs? (required)

On a scale of 1 to 10, how self-directed are you? (10 is high, 1 is low) (required)

A-DA Programs