WDB Application



Are you eligible to work in the United States?


SECTION I: DEMOGRAPHIC INFORMATION

Do you have Dependent Children?


Do you have Access to a Computer and the Internet?


Are you (or were you previously) in Foster Care?


Upon completion of training, do you intend to seek full-time paid employment in the occupation in which you were trained?


Are you a Veteran?


Are you a Spouse of a Veteran?


Unemployment Insurance Benefits (Check all that apply):



SECTION II: ASSISTANCE NEEDED TO OBTAIN CAREER GOAL

Funding is available for all or most of these situations. Your answers help us see what programs you may be eligible for. All information is confidential and held in the strictest of confidence.
Check all of the following that apply to you:









If you have additional barriers, please include in Section VI.

SECTION III: EMPLOYMENT AND EXPERIENCE

Have you worked during the last six months?


Have you ever been fired or forced to resign from a job?


List your employment experience (most recent first)

If you have additional work experience, please include in Section VI.

SECTION IV: HOUSEHOLD INFORMATION

List family members living in your home and any wage and benefit amount they’ve received in the past six months:
YOUR INFORMATION:
Wages: $
TANF: $
SNAP: $
UI: $
 
(continued)
SSI: $
SSDI: $
Survivors: $
Retirement: $
 
(continued)
Child Support: $
Veteran’s Assistance: $
Other income: $
 

Family Member's information:
Wages: $
TANF: $
SNAP: $
UI: $
 
(continued)
SSI: $
SSDI: $
Survivors: $
Retirement: $
 
(continued)
Child Support: $
Veteran’s Assistance: $
Other income: $
 

Family Member's information:
Wages: $
TANF: $
SNAP: $
UI: $
 
(continued)
SSI: $
SSDI: $
Survivors: $
Retirement: $
 
(continued)
Child Support: $
Veteran’s Assistance: $
Other income: $
 

Family Member's information:
Wages: $
TANF: $
SNAP: $
UI: $
 
(continued)
SSI: $
SSDI: $
Survivors: $
Retirement: $
 
(continued)
Child Support: $
Veteran’s Assistance: $
Other income: $
 
If you have additional family members in your home, please include in Section VI.

SECTION V: SUITABILITY INFORMATION

The New River/Mount Rogers Workforce Development Board programs provide financial assistance for individuals who want to improve themselves through training and employment. Please tell us a little about yourself, your career goals, and how these programs can help support you in successfully accomplishing your goals. Use this opportunity to provide as much detail about yourself.

Certification(Required)

SECTION VI: ADDITIONAL INFORMATION

Applicant and/or Staff: Include any information about this applicant not otherwise on this form that can help determine the applicant’s eligibility and suitability for program funding.

The NR/MR Workforce Development Board is an Equal Opportunity Employer/Program. Auxiliary Aids and Services are available upon request to individuals with disabilities. It is the fundamental policy of this organization not to discriminate on the basis of race, color, religion, sex, national origin, or age with respect to recruitment, hiring, promotion, and other terms and conditions of employment.