One moment please...
Career Resource Center Boot Camp Application
Contact Information
Name
*
First Name
Last Name
Email
*
Verify Email
*
Mobile Phone
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
DEMOGRAPHIC INFORMATION
If you are an Illinois resident, what County do you live in?
What Township do you reside in?
*
select one
Algonquin Township
Antioch Township
Avon Township
Benton Township
Deerfield Township
Downers Grove Township
Ela Township
Elk Grove Township
Fremont Township
Grant Township
Greenwood Township
Hampshire Township
Lake Villa Township
Leyden Township
Libertyville Township
Lyon Charter Township
Maine Township
McHenry Township
Milton Township
Moraine Township
New Trier Township
Newport Township
Niles Township
Northfield Township
Palatine Township
Proviso Township
Schaumburg Township
Shields Township
Vernon Township
Wauconda Township
Warren Township
Waukegan Township
Wayne Township
West Deerfield Township
Wheeling Township
York Township
Other (you know your Illinois Township, but it is not listed)
Unknown (you live in Illinois, but do not know your Township)
Out of Region (you do not live in Illinois)
Birthday
*
(mm/dd/yyyy)
Gender
*
Female
Male
Marital Status
*
select one
Single
Married
Separated
Divorced
Widowed
EDUCATIONAL BACKGROUND
Under Graduate Degree/Institution
*
N/A may be entered here.
Graduate Degree/Institution
*
N/A may be entered here.
Certifications/Professional Designations
*
N/A may be entered here.
BOOT CAMP SPECIFIC QUESTIONS
How did you hear about CRC/Kick Start Your Career Boot Camp??
*
Family/Friend
CRC Member/Alumni
Internet
CRC Booth
Media
Religous
IDES Office/Township
Library
Career Center
Networking Group
Social Service Agency
College
Professional Referral
Other/Unknown
Attendance at all 4 sessions is a requirement of acceptance to the Boot Camp. Can you commit to attend all 4 sessions via Zoom from 6:00pm - 8:15 pm on 2/28, 3/2, 3/7, & 3/9?
*
Yes
No
What are you expecting to get out of the Boot Camp?
*
Why are you a strong candidate for the Boot Camp?
*
EMPLOYMENT HISTORY
Please describe your current employment status:
*
(indicate ALL that apply)
Employed but looking
Underemployed
Unemployed
Returning to work after a career break
Looking for a career change
Recent college grad
Other
If you selected "Other" for the last question about Unemployment Status, please explain:
Last/Current Employer
*
Last/Current Position
*
Date of Employment
*
Start Date & End Date
Salary or Hourly Rate
*
Reason for Leaving
*
Are you currently receiving or have you received any of the following government assistance in the past year?
*
Check all that apply,
Unemployment Pay
SNAP
Medicaid
Other
No assistance
If you selected "Other" for the last question about government assistance, please explain:
Is there anything else you would like us to know to consider you for the Kick Start Your Career Boot Camp?