Pre-Screening & Referral FormDate(Required)Applicant Name(Required)Applicant Email(Required)Applicant Phone Number(Required)Please check the Training Program you are interested in:(Required) Certified HVAC Training Program NCCER Tiny House Construction Training Program Class A CDL Truck Driver Training Program The Certified HVAC Training Program will take place over 4 weeks, every Monday-Thursday from 9am to 2pm. Classes will be in-person at Goodwill in the HVAC Training Lab. The tuition cost for the class is $2,000 and we have an assortment of funding & scholarship options. An appointment with Jason Norris, Job Development Manager, can be made to discuss funding/scholarship opportunities. The NCCER Tiny House Construction Training Program will take place over 8 weeks, every Tuesday, Wednesday, and Thursday from 9am to 1pm. Classes will be both in the classroom using a computer and hands-on in a warehouse. Once training is completed, you will be able to take an assessment to get a NCCER CORE Certification to begin a job search or follow up with the Carpentry Programs. You will be provided with a calendar of classroom structure and will be expected to attend classes on time throughout those 8 weeks. The Class A CDL Truck Driver Training Program will take place over 5-6 weeks. Monday-Fri day from 8am to 5pm. Classes will be both virtual & in-person with the first 2 weeks being virtual. The tuition cost for the class is $3,625 and we have an assortment of funding & scholarship options. An appointment with Jason Norris, Job Development Manager, can be made to discuss funding/scholarship opportunities.Certified HVACEligibility(Required)Are you at least 18 years of age? Yes No The HVAC industry requires your ability and willingness to accept certain conditions and perform functions such as the following: Working in hot and cold temperatures typically outdoors Working in cramped spaces Ability to work unsupervised Working directly with homeowners or businesses ConditionsWill any of these restrictions/conditions cause a problem for you? Yes No NCCER Tiny House ConstructionEligibilityAre you at least 18 years of age? Yes No The construction industry requires your ability and willingness to accept certain conditions and perform functions such as the following: Climbing ladders and scaffolding Wearing uniforms and proper equipment Using porta johns Eliminating presence of all jewelry ConditionsWill any of these restrictions/conditions cause a problem for you? Yes No Class A CDL Truck DriverEligibilityAre you at least 18 years of age? Yes No Driver’s LicenseDo you have a valid NC driver’s license? Yes No Driving RecordHave you had any driving infractions in the last 3 years (excessive speeding, car accidents, etc.) Yes No The Truck Driving industry requires your ability and willingness to accept certain conditions and perform functions such as the following: Being on the road in a truck for long periods of time Potentially loading and unloading freight Ability to communicate with dispatchers Ability to follow GPS coordinates ConditionsWill any of these restrictions/conditions cause a problem for you? Yes No Employment History1. Are you currently employed? Yes No 1a. If yes, will you be taking this course to advance with this company? Yes No 2. What does your job history look like? Please list most recent employers:3. Have you been terminated from employment? Yes No 3a. If yes, please explain:4. Are there any challenges in life that would prevent you from being present and prepared every day of the training period (child care, pending court dates, doctor’s appointments, etc.)? Yes No 4a. If yes, please explain:5. Do you have reliable transportation to and from class? Yes No 6. Why are you interested in this particular training program?7. What benefits are you hoping to obtain from the program and what would motivate you to succeed?8. How well do you function working in a group setting?9. Will you be committed to finding employment upon completion of the program? Yes No 10. Please check how will you pay for the program’s tuition: I will pay out-of-pocket. I will apply for a scholarship (GED/HS Diploma required). I will do in-house financing (HVAC Training Program only). Personal History1. Are you currently experiencing homelessness? Yes No 1a. If so, please explain:2. Would you need any accommodations due to physically or mentally limiting conditions? Yes No 2a. If yes, please explain:3. Do you have any medical conditions that we need to know about? Yes No 3a. If yes, please explain:4. Have you ever been convicted of a felony? Yes No a. If so please list convictions:5. Is language a barrier for you? Yes No 5a. If so, please list your Native Language:6. How comfortable are you with the use of a computer (Not at all, Somewhat, Very well) ? Very well Somewhat Not at all 7. Do you know how to use the internet? Yes No 8. Have you ever used any Microsoft Office applications? Yes No 8a. If so, which ones?9. Do you have a current resume? Yes No 10. Do you know how to save a document on the computer? Yes No Δ
