Contact InformationName(Required) First Last Email Cell Phone #(Required)Home Phone #Address(Required) Street Address Apartment/Unit # (if applicable) City State Zip Code Birthdate MM slash DD slash YYYY Gender(Required) Female Male Trans Female Trans Male Gender Nonconforming Other Ethnicity(Required) Hispanic/Latino Not hispanic or latino Other Race(Required) American Indian or Alaskan Native Asian African American/Black Native Hawaiian or other Pacific Islander White American Indian or Alaskan Native and White Asian and White Black or African American and White American Indian or Alaskan Native and Black or African American Other Multiple Race Other (please select one)What is your primary languageEnglishSpanishAhmaricAlbanianAmerican Sign LanguageAmerican Sign Language (ASL)ArabicBanglaBengaliBosnianCape Verdean CreoleChineseDutchEweFrenchGermanHaitian CreoleHindiIndonesianItalianJapaneseKhmerLugandaMaay MaayMandingoNepaliOtherPortuguesePunjabiRussianSomaliSwahiliTagalogTigryanaUrduVietnameseWhat is your secondary language? (if applicable)EnglishSpanishAhmaricAlbanianAmerican Sign LanguageAmerican Sign Language (ASL)ArabicBanglaBengaliBosnianCape Verdean CreoleChineseDutchEweFrenchGermanHaitian CreoleHindiIndonesianItalianJapaneseKhmerLugandaMaay MaayMandingoNepaliOtherPortuguesePunjabiRussianSomaliSwahiliTagalogTigryanaUrduVietnameseWhat is your English proficiency?(Required) Fluent Near native Advanced Intermediate Low-intermediate Beginner Highest level of education completed(Required) Less than high school graduate High School Graduate/GED 2-year college Bachelor's degree Graduate school/degree Country of highest level of education United States Not in the United States Are you a US Veteran? Yes No Active Duty Type of Driver's License None Driver's license CDL CDL with bus endorsement Do you have a CORI?(Required) Yes No Prefer not to state/Unkown Household InformationNumber of adults in household(Required)Number onlyNumber of children in household(Required)Number onlyAnnual household income(Required)Required for reporting purposes (numbers only)Current or most recent employment informationWhat is your current employment status?(Required)Employed full-timeEmployed part-timeFull-time studentUnemployedWho is your current employer, or who was your most recent employer? What is/was your job title? What city is/was this job located in? What is/was your hourly wage?(Required)Enter $0 if you are not currently employedPlease enter a number from 0 to 199.How many hours per week?Number onlyResume and Career GoalsDo you have a resume?(Required) Yes No Upload a copy of your resume here (optional)Max. file size: 10 MB.Primary Job Interest Category(Required)Business ServicesEducation & TrainingEquipment Installation & RepairFacility & Grounds Cleaning & MaintenanceFinancial/Insurance ServicesFood ServicesGuest AccommodationsHealthcare PractitionerHealthcare Support/Allied HealthInformation TechnologyManufacturing/ProductionMedia/Entertainment/LeisureOffice and Administrative SupportPersonal Care & ServiceProtective ServicesSalesSciences (Life/Physical/Bio)Skilled TradesTransportation and Material MovingSecondary Interest(Required)Business ServicesEducation & TrainingEquipment Installation & RepairFacility & Grounds Cleaning & MaintenanceFinancial/Insurance ServicesFood ServicesGuest AccommodationsHealthcare PractitionerHealthcare Support/Allied HealthInformation TechnologyManufacturing/ProductionMedia/Entertainment/LeisureOffice and Administrative SupportPersonal Care & ServiceProtective ServicesSalesSciences (Life/Physical/Bio)Skilled TradesTransportation and Material MovingJob Skills(Required)(check all that apply) Administrative Assistant/ Executive Secretary Bartender Bellperson Billing / Accounting Busboy/waiter’s assistant Carpentry CNA Community Activist Concierge Content Manager Cook Digital Marketing Manager Digital Media Supervisor Dishwasher Electrician Engagement Coordinator Equipment Installation & Repair Front Desk / Guest Services Grant writer Grounds cleaning Home health aide Host/hostess Housekeeping Job Coach Lab technician Lawn care Mail clerk Masonry MBTA Nursing Office Manager Online Community Manager Painting Patient registration Phone operator Plant Care Plumbing Public Relations Receptionist Sales Shuttle / Bus Driver Social Justice Advocate Social Media Analyst Teacher Teachers Aide Technical writer Tour guide Trainer Valet Waiter/waitress Web page designer Welder Other (please discuss during intake) Please list any career goals here:SCC InformationHow did you hear about Somerville Community Corporation? Agency Referral Community Event Email Employer Flyer Former First Source Participant SCALE SCC SCC Job Fair Website/Social Media Other If other Agency Name Which website or social media platform? CertificationCertification(Required) By checking this box I certify that the information here is correct to the best of my knowledge
