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Green Job Corps Application

(updated 11-24-09)

Green Job Corps is a semester long program through City College of San Francisco that will prepare students for

college and green careers. The program will be offered at 3 City College campuses during morning and evening classes.

For more information contact Kim Fox with Goodwill at (415) 575-2206.

Submit applications to Kim Fox, Goodwill Industries, 1500 Mission Street, San Francisco, CA 94103; fax (415) 575-2170

(attention Kim Fox); email

The information collected in this form will be kept confidential and will be used to help us provide services that best meet your employment-related needs. Please note that

all fields marked with an asterisk (*) are required; all other information can be considered optional. We appreciate your efforts to fill out this form as completely as possible.

Thank you for your cooperation.

*FIRST NAME

MIDDLE INITAL

SOCIAL SECURITY NUMBER

*LAST NAME

*ADDRESS

*TELEPHONE 1:

Pick one

*CITY

*STATE

*ZIP CODE

TELEPHONE 2:

Pick one

ALTERNATE / EMERGENCY CONTACT INFO

* EDUCATION

Name

Below 12th grade

*BIRTHDATE

GED

Phone

High School Diploma

*I AM CURRENTLY

*GENDER

Bachelors

Male

Employed

Other

Female

Not Employed

If you are male, are you registered for the selective service

What proof of identity and work authorization can you provide?

(program requirement):

(check all that apply):

Picture ID

Social Security Card

Yes

Driver License

Birth Certificate

No (information will be provided

to help you register)

US Passport

How did you hear about the Green Job Corps Program?

Agency Referral

Friend

Employer

(Name)

Walk-In

Yellow Pages

Family Member

WIA Case Manager

Other

Brochure

I understand that the information on this form has been provided to the Green Job Corps Program in order to make the most appropriate training services available

to me. City College and the San Francisco One-Stop Career Link Centers have my approval to share this information only with the agencies providing services

through or operating the Green Job Corps Program.

Signature

Date

Green Job Corps Partners

• City College of San Francisco: 50 Phelan Ave, San Francisco, CA

• San Francisco Conservation Corps: 102 Fort Mason, San Francisco, CA

94112; Tel. (415) 239-3000

94123; Tel. 415-928-7417 x313

• San Francisco Office of Economic and Workforce Development: 1 Dr.

• Goodwill Industries of San Francisco, San Mateo, and Marin Counties:

Carlton B. Goodlett Pl., City Hall Rm. 448, San Francisco, CA 94102;

1500 Mission Street, San Francisco, CA 94103: Tel: 415-575-2101