Name
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Alternate Phone
(###)
###
####
Email
*
Gender Identity
Race / Ethnicity
Why you are interested in this program?
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Check all of the culinary careers that interest you:
Have you ever worked in a professional kitchen?
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If so, please list the following information about your kitchen experience: employer, position, and dates of employment:
*
Do you have any informal or formal culinary training? If so, please describe:
*
Please list the names and contact info of 2 people who know you well and can speak to your strengths and potential (personal and professional)
*
Include their names, relationship to you, company, and phone number *
Do you have a valid driver's license?
*
Do you have a state issued ID?
*
Do you have a social security card?
*
Do you have your HS diploma/GED?
*
If no, are you enrolled in a GED program currently?
*
Are you able to work in the United States legally ?
*
Are you a Veteran?
*
Are you currently serving in the military?
*
If you have education or training after/beyond high school, please enter it here:
Are you currently employed? If yes, please enter the name of your employer and your schedule in the space below:
Please list any non-kitchen related work experience below including: employer, position, and dates of employment:
*
Do any of the following apply to you?
*
Check any public assistance programs you receive benefits from:
*
What specific careers are you interested in learning more about?
*
The training is 12 consecutive weeks, 10am – 3:30pm, Monday through Friday. Are you able to commit to ALL of these training hours? What is your transportation plan for arriving at the POIC Kitchen every morning?
*
If you are currently working, how will you balance your work schedule so that you can participate in ALL of the training hours?
What date are you available to begin training?
*
MM
DD
YYYY
What else would you like us to know about you?
In what areas will you need support from POIC? Are there any barriers that might get in the way of you fully participating?
*
Childcare, scheduling conflicts, other training, etc.
What other questions do you have for us?
