{"id":471,"date":"2026-02-01T15:33:50","date_gmt":"2026-02-01T15:33:50","guid":{"rendered":"https:\/\/wpdev.billychandler.com\/nrmr\/?page_id=471"},"modified":"2026-05-10T13:31:23","modified_gmt":"2026-05-10T13:31:23","slug":"wdb-application","status":"publish","type":"page","link":"https:\/\/wpdev.billychandler.com\/nrmr\/applications\/wdb-application\/","title":{"rendered":"Workforce Development Board (WDB) Application"},"content":{"rendered":"<div class='fluentform ff-default fluentform_wrapper_5 ffs_default_wrap'><form data-form_id=\"5\" id=\"fluentform_5\" class=\"frm-fluent-form fluent_form_5 ff-el-form-top ff_form_instance_5_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_5_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Workforce Development Board Application<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='471' \/><input type=\"hidden\" id=\"_fluentform_5_fluentformnonce\" name=\"_fluentform_5_fluentformnonce\" value=\"a8970a2dd5\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/nrmr\/wp-json\/wp\/v2\/pages\/471\" \/><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_datetime' id='label_ff_5_datetime' aria-label=\"Application Date\">Application Date<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Application Date Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" id=\"ff_5_datetime\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime\"  aria-invalid='false' aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Do you need help getting a job or do you need help with training and training-related expenses?\">Do you need help getting a job or do you need help with training and training-related expenses?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4ed38201d77afc79aa78c5110d1fe7f7'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"I want help getting a job and do not wish to enroll in training now.  (Complete Section I only.)\"  id='input_radio_4ed38201d77afc79aa78c5110d1fe7f7' aria-label='I want help getting a job and do not wish to enroll in training now.  (Complete Section I only.)' aria-invalid='false' aria-required=true> <span>I want help getting a job and do not wish to enroll in training now.  (Complete Section I only.)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_dd75f78eb911c30fe066875a2eb8df7b'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"I need help with training and training-related expenses. (Complete All Sections)\"  id='input_radio_dd75f78eb911c30fe066875a2eb8df7b' aria-label='I need help with training and training-related expenses. (Complete All Sections)' aria-invalid='false' aria-required=true> <span>I need help with training and training-related expenses. (Complete All Sections)<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Are you eligible to work in the United States?\">Are you eligible to work in the United States?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_21309465814a74785b84fb3e2b43fbc4'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_1_21309465814a74785b84fb3e2b43fbc4' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_b191619008ef6d236a9ff35179f03157'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"No (If no, contact staff before completing)\"  id='input_radio_1_b191619008ef6d236a9ff35179f03157' aria-label='No (If no, contact staff before completing)' aria-invalid='false' aria-required=true> <span>No (If no, contact staff before completing)<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text' id='label_ff_5_input_text' aria-label=\"What is your Career Goal?\">What is your Career Goal?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_5_input_text\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_1' id='label_ff_5_input_text_1' aria-label=\"How did you hear about us?\">How did you hear about us?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" id=\"ff_5_input_text_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-5_1\" ><h3 class='ff-el-section-title'>Section I: Demographic Information<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_2' id='label_ff_5_input_text_2' aria-label=\"Name\">Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" data-name=\"input_text_2\" id=\"ff_5_input_text_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_3' id='label_ff_5_input_text_3' aria-label=\"Address (including City, State, ZIP)\">Address (including City, State, ZIP)<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" data-name=\"input_text_3\" id=\"ff_5_input_text_3\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_4' id='label_ff_5_input_text_4' aria-label=\"Home Phone\">Home Phone<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" data-name=\"input_text_4\" id=\"ff_5_input_text_4\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_5' id='label_ff_5_input_text_5' aria-label=\"Cell Phone\">Cell Phone<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_5\" class=\"ff-el-form-control\" data-name=\"input_text_5\" id=\"ff_5_input_text_5\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_email' id='label_ff_5_email' aria-label=\"Email\">Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_5_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_email_1' id='label_ff_5_email_1' aria-label=\"Secondary Email\">Secondary Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email_1\" id=\"ff_5_email_1\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_datetime_1' id='label_ff_5_datetime_1' aria-label=\"Date of Birth\">Date of Birth<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date of Birth Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime_1\" id=\"ff_5_datetime_1\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime_1\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_6' id='label_ff_5_input_text_6' aria-label=\"Highest Educational Level Completed\">Highest Educational Level Completed<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_6\" class=\"ff-el-form-control\" data-name=\"input_text_6\" id=\"ff_5_input_text_6\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_7' id='label_ff_5_input_text_7' aria-label=\"Last School Attended\">Last School Attended<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_7\" class=\"ff-el-form-control\" data-name=\"input_text_7\" id=\"ff_5_input_text_7\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_datetime_2' id='label_ff_5_datetime_2' aria-label=\"Date Last Attended\">Date Last Attended<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date Last Attended Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime_2\" id=\"ff_5_datetime_2\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime_2\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_description' id='label_ff_5_description' aria-label=\"List any certifications or degrees your currently hold\">List any certifications or degrees your currently hold<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_5_description\" name=\"description\" id=\"ff_5_description\" class=\"ff-el-form-control\" rows=\"2\" cols=\"2\" data-name=\"description\" ><\/textarea><\/div><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you have dependent children?\">Do you have dependent children?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_e18b4369d01b2809b4ce4675d5707385'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_2_e18b4369d01b2809b4ce4675d5707385' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_a66964e52609939d10be2941bfbc6c38'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_2_a66964e52609939d10be2941bfbc6c38' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_8' id='label_ff_5_input_text_8' aria-label=\"If yes, how many?\">If yes, how many?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_8\" class=\"ff-el-form-control\" data-name=\"input_text_8\" id=\"ff_5_input_text_8\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you have access to a computer and the Internet?\">Do you have access to a computer and the Internet?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_04b2e933bcbe90f5777f7298c1a2fa29'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_3_04b2e933bcbe90f5777f7298c1a2fa29' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_c05bed3149018c11ccc6dd717420704e'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_3_c05bed3149018c11ccc6dd717420704e' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are you (or were you previously) in Foster Care?\">Are you (or were you previously) in Foster Care?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_8c95c918ca842ac2131c05df96c79885'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_4_8c95c918ca842ac2131c05df96c79885' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_1e418ede412ac6635c9ec4beff0f7854'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_4_1e418ede412ac6635c9ec4beff0f7854' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Upon completion of training, do you intend to seek full-time paid employment in the occupation in which you were trained?\">Upon completion of training, do you intend to seek full-time paid employment in the occupation in which you were trained?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_355323d962f73fcc97d8cf0a57ff5eac'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_5_355323d962f73fcc97d8cf0a57ff5eac' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_e451569f7b834e16ac926ad39ec5a4c6'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_5_e451569f7b834e16ac926ad39ec5a4c6' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_9' id='label_ff_5_input_text_9' aria-label=\"Upon completion of training, where do you intend to seek employment?\">Upon completion of training, where do you intend to seek employment?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_9\" class=\"ff-el-form-control\" data-name=\"input_text_9\" id=\"ff_5_input_text_9\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div data-name=\"ff_cn_id_6\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are you a Veteran?\">Are you a Veteran?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_6_b44671a83d89f6adae91388131e581ff'><input  type=\"radio\" name=\"input_radio_6\" data-name=\"input_radio_6\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_6_b44671a83d89f6adae91388131e581ff' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_6_a76b56b78dcc3a316bb0c9761489f878'><input  type=\"radio\" name=\"input_radio_6\" data-name=\"input_radio_6\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_6_a76b56b78dcc3a316bb0c9761489f878' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are you a spouse of a Veteran?\">Are you a spouse of a Veteran?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_38c6a0e67dbcd1511e219fa7decf6aec'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_7_38c6a0e67dbcd1511e219fa7decf6aec' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_924935d4fb3adfaa9950a676b18be508'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_7_924935d4fb3adfaa9950a676b18be508' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_7\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_10' id='label_ff_5_input_text_10' aria-label=\"Branch of Service\">Branch of Service<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_10\" class=\"ff-el-form-control\" data-name=\"input_text_10\" id=\"ff_5_input_text_10\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_11' id='label_ff_5_input_text_11' aria-label=\"Final Rank\">Final Rank<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_11\" class=\"ff-el-form-control\" data-name=\"input_text_11\" id=\"ff_5_input_text_11\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_8\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_12' id='label_ff_5_input_text_12' aria-label=\"Discharge Date\">Discharge Date<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_12\" class=\"ff-el-form-control\" data-name=\"input_text_12\" id=\"ff_5_input_text_12\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_13' id='label_ff_5_input_text_13' aria-label=\"Type of Discharge\">Type of Discharge<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_13\" class=\"ff-el-form-control\" data-name=\"input_text_13\" id=\"ff_5_input_text_13\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_14' id='label_ff_5_input_text_14' aria-label=\"Special Training Received\">Special Training Received<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_14\" class=\"ff-el-form-control\" data-name=\"input_text_14\" id=\"ff_5_input_text_14\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_15' id='label_ff_5_input_text_15' aria-label=\"If you are unemployed, list number of weeks unemployed in the past 26 weeks.\">If you are unemployed, list number of weeks unemployed in the past 26 weeks.<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_15\" class=\"ff-el-form-control\" data-name=\"input_text_15\" id=\"ff_5_input_text_15\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Unemployment Insurance Benefits (Check all that apply)\">Unemployment Insurance Benefits (Check all that apply)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_44312c3b712a002cd70ed334433db4d9'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Applied\"  id='checkbox_44312c3b712a002cd70ed334433db4d9' aria-label='Applied' aria-invalid='false' aria-required=false> <span>Applied<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3a6d7dab4313b77ba36d73146a85dde1'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Received\"  id='checkbox_3a6d7dab4313b77ba36d73146a85dde1' aria-label='Received' aria-invalid='false' aria-required=false> <span>Received<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2ce388b394a6ea6b268974d2dca6a951'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Exhausted\"  id='checkbox_2ce388b394a6ea6b268974d2dca6a951' aria-label='Exhausted' aria-invalid='false' aria-required=false> <span>Exhausted<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_16' id='label_ff_5_input_text_16' aria-label=\"Available Work Hours\">Available Work Hours<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_16\" class=\"ff-el-form-control\" data-name=\"input_text_16\" id=\"ff_5_input_text_16\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-5_2\" ><h3 class='ff-el-section-title'>Section II: Assistance Needed to Obtain Career Goal<\/h3><div class='ff-section_break_desk'><p>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.<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Check all of the following that apply to you:\">Check all of the following that apply to you:<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_2bfee34f23288dcaea9d87ff7402fa72'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"In a low-wage job\"  id='checkbox_1_2bfee34f23288dcaea9d87ff7402fa72' aria-label='In a low-wage job' aria-invalid='false' aria-required=false> <span>In a low-wage job<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_cc958c6e00ffcf151eb247747036be5a'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Disability\"  id='checkbox_1_cc958c6e00ffcf151eb247747036be5a' aria-label='Disability' aria-invalid='false' aria-required=false> <span>Disability<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_4b03071c4437f00d5598595a74ff26aa'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Homeless\"  id='checkbox_1_4b03071c4437f00d5598595a74ff26aa' aria-label='Homeless' aria-invalid='false' aria-required=false> <span>Homeless<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_02455690d6f253e9632ee0a0b6d404d5'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Childcare issues\"  id='checkbox_1_02455690d6f253e9632ee0a0b6d404d5' aria-label='Childcare issues' aria-invalid='false' aria-required=false> <span>Childcare issues<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_8db8a253e95220ede1a846e8d3c0f201'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Transportation issues\"  id='checkbox_1_8db8a253e95220ede1a846e8d3c0f201' aria-label='Transportation issues' aria-invalid='false' aria-required=false> <span>Transportation issues<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_b033d5826d3632047792db3a700a063a'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Struggles with Reading\/Writing\/Math\"  id='checkbox_1_b033d5826d3632047792db3a700a063a' aria-label='Struggles with Reading\/Writing\/Math' aria-invalid='false' aria-required=false> <span>Struggles with Reading\/Writing\/Math<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_f5dd5a696e8e59c9a4cb8cf0921eb1c7'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Struggles with Technology\"  id='checkbox_1_f5dd5a696e8e59c9a4cb8cf0921eb1c7' aria-label='Struggles with Technology' aria-invalid='false' aria-required=false> <span>Struggles with Technology<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_f7f3b8102567f2dd73865843be16bf49'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"English is not my primary language\"  id='checkbox_1_f7f3b8102567f2dd73865843be16bf49' aria-label='English is not my primary language' aria-invalid='false' aria-required=false> <span>English is not my primary language<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_8a9ab430f64d15f1bd89246efc2f5ccd'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Substance Use (alcohol, street drugs, prescription drugs)\"  id='checkbox_1_8a9ab430f64d15f1bd89246efc2f5ccd' aria-label='Substance Use (alcohol, street drugs, prescription drugs)' aria-invalid='false' aria-required=false> <span>Substance Use (alcohol, street drugs, prescription drugs)<\/span><\/label><\/div><\/div><\/div><div data-name=\"ff_cn_id_9\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 66.87%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_17' id='label_ff_5_input_text_17' aria-label=\"Criminal History: Charges\">Criminal History: Charges<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_17\" class=\"ff-el-form-control\" data-name=\"input_text_17\" id=\"ff_5_input_text_17\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.13%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_18' id='label_ff_5_input_text_18' aria-label=\"State\">State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_18\" class=\"ff-el-form-control\" data-name=\"input_text_18\" id=\"ff_5_input_text_18\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_10\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 66.87%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_19' id='label_ff_5_input_text_19' aria-label=\"List any Pending Charges\">List any Pending Charges<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_19\" class=\"ff-el-form-control\" data-name=\"input_text_19\" id=\"ff_5_input_text_19\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.13%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_20' id='label_ff_5_input_text_20' aria-label=\"State\">State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_20\" class=\"ff-el-form-control\" data-name=\"input_text_20\" id=\"ff_5_input_text_20\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-5_3\" ><p><em>If you have additional barriers, please include in Section VI.<\/em><\/p><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-5_4\" ><h3 class='ff-el-section-title'>Section III: Employment and Experience<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Have you worked during the last six months?\">Have you worked during the last six months?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8_4550746c3d994d0c50bd514804499317'><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_8_4550746c3d994d0c50bd514804499317' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8_e16c94e2003cff77409533a809af74db'><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_8_e16c94e2003cff77409533a809af74db' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_21' id='label_ff_5_input_text_21' aria-label=\"If yes, what is the total gross amount you earned?\">If yes, what is the total gross amount you earned?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_21\" class=\"ff-el-form-control\" data-name=\"input_text_21\" id=\"ff_5_input_text_21\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Have you ever been fired or forced to resign from a job?\">Have you ever been fired or forced to resign from a job?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_9_9ae9a1672d82595dd6b6910a8fdb7f91'><input  type=\"radio\" name=\"input_radio_9\" data-name=\"input_radio_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_9_9ae9a1672d82595dd6b6910a8fdb7f91' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_9_7ba95f4cb39feca129544c9809615a61'><input  type=\"radio\" name=\"input_radio_9\" data-name=\"input_radio_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_9_7ba95f4cb39feca129544c9809615a61' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_22' id='label_ff_5_input_text_22' aria-label=\"Text If yes, please explain\">Text If yes, please explain<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_22\" class=\"ff-el-form-control\" data-name=\"input_text_22\" id=\"ff_5_input_text_22\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-5_5\" ><p><strong>List your employment experience<\/strong> (<em>most recent first<\/em>)<\/p><\/div><div data-name=\"ff_cn_id_11\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 67.07%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_23' id='label_ff_5_input_text_23' aria-label=\"Company\">Company<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_23\" class=\"ff-el-form-control\" data-name=\"input_text_23\" id=\"ff_5_input_text_23\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 32.93%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_24' id='label_ff_5_input_text_24' aria-label=\"Phone\">Phone<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_24\" class=\"ff-el-form-control\" data-name=\"input_text_24\" id=\"ff_5_input_text_24\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_12\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 67.07%;'><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_address_1_city_' id='label_ff_5_address_1_city_' aria-label=\"City\">City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_5_address_1_city_\" class=\"ff-el-form-control\" placeholder=\"City\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_address_1_state_' id='label_ff_5_address_1_state_' aria-label=\"State\">State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[state]\" id=\"ff_5_address_1_state_\" class=\"ff-el-form-control\" placeholder=\"State\" data-key_name=\"state\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 32.93%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_25' id='label_ff_5_input_text_25' aria-label=\"Job Title\">Job Title<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_25\" class=\"ff-el-form-control\" data-name=\"input_text_25\" id=\"ff_5_input_text_25\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_13\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_26' id='label_ff_5_input_text_26' aria-label=\"Wage\">Wage<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_26\" class=\"ff-el-form-control\" data-name=\"input_text_26\" id=\"ff_5_input_text_26\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_datetime_3' id='label_ff_5_datetime_3' aria-label=\"Date Employment Begin\">Date Employment Begin<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date Employment Begin Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime_3\" id=\"ff_5_datetime_3\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime_3\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_datetime_4' id='label_ff_5_datetime_4' aria-label=\"Date Employment Ended\">Date Employment Ended<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date Employment Ended Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime_4\" id=\"ff_5_datetime_4\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime_4\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_14\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.23%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_27' id='label_ff_5_input_text_27' aria-label=\"Hours Worked per Week\">Hours Worked per Week<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_27\" class=\"ff-el-form-control\" data-name=\"input_text_27\" id=\"ff_5_input_text_27\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 66.77%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_28' id='label_ff_5_input_text_28' aria-label=\"Job Duties\">Job Duties<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_28\" class=\"ff-el-form-control\" data-name=\"input_text_28\" id=\"ff_5_input_text_28\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_29' id='label_ff_5_input_text_29' aria-label=\"Reason for Leaving\">Reason for Leaving<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_29\" class=\"ff-el-form-control\" data-name=\"input_text_29\" id=\"ff_5_input_text_29\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-5_6\" ><p><em>If you have additional work experience, please include in Section VI.<\/em><\/p><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-5_7\" ><h3 class='ff-el-section-title'>Section IV: Household Information<\/h3><div class='ff-section_break_desk'><p>List family members living in your home and any wage and benefit amount they\u2019ve received in the past six months:<\/p><\/div><hr \/><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-5_8\" ><h4>Your Information:<\/h4><\/div><div data-name=\"ff_cn_id_15\"  class='ff-t-container ff-column-container ff_columns_total_4 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_30' id='label_ff_5_input_text_30' aria-label=\"Wages: $\">Wages: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_30\" class=\"ff-el-form-control\" data-name=\"input_text_30\" id=\"ff_5_input_text_30\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_31' id='label_ff_5_input_text_31' aria-label=\"TANF: $\">TANF: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_31\" class=\"ff-el-form-control\" data-name=\"input_text_31\" id=\"ff_5_input_text_31\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_32' id='label_ff_5_input_text_32' aria-label=\"SNAP: $\">SNAP: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_32\" class=\"ff-el-form-control\" data-name=\"input_text_32\" id=\"ff_5_input_text_32\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-4' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_33' id='label_ff_5_input_text_33' aria-label=\"UI: $\">UI: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_33\" class=\"ff-el-form-control\" data-name=\"input_text_33\" id=\"ff_5_input_text_33\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_16\"  class='ff-t-container ff-column-container ff_columns_total_4 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_34' id='label_ff_5_input_text_34' aria-label=\"SSI: $\">SSI: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_34\" class=\"ff-el-form-control\" data-name=\"input_text_34\" id=\"ff_5_input_text_34\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_35' id='label_ff_5_input_text_35' aria-label=\"SSDI: $\">SSDI: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_35\" class=\"ff-el-form-control\" data-name=\"input_text_35\" id=\"ff_5_input_text_35\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_36' id='label_ff_5_input_text_36' aria-label=\"Survivors: $\">Survivors: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_36\" class=\"ff-el-form-control\" data-name=\"input_text_36\" id=\"ff_5_input_text_36\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-4' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_37' id='label_ff_5_input_text_37' aria-label=\"Retirement: $\">Retirement: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_37\" class=\"ff-el-form-control\" data-name=\"input_text_37\" id=\"ff_5_input_text_37\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_17\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_38' id='label_ff_5_input_text_38' aria-label=\"Child Support: $\">Child Support: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_38\" class=\"ff-el-form-control\" data-name=\"input_text_38\" id=\"ff_5_input_text_38\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_39' id='label_ff_5_input_text_39' aria-label=\"Veteran&#039;s Assistance: $\">Veteran's Assistance: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_39\" class=\"ff-el-form-control\" data-name=\"input_text_39\" id=\"ff_5_input_text_39\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_40' id='label_ff_5_input_text_40' aria-label=\"Other income: $\">Other income: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_40\" class=\"ff-el-form-control\" data-name=\"input_text_40\" id=\"ff_5_input_text_40\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_18\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_49' id='label_ff_5_input_text_49' aria-label=\"Child Support: $\">Child Support: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_49\" class=\"ff-el-form-control\" data-name=\"input_text_49\" id=\"ff_5_input_text_49\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_50' id='label_ff_5_input_text_50' aria-label=\"Veteran&#039;s Assistance: $\">Veteran's Assistance: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_50\" class=\"ff-el-form-control\" data-name=\"input_text_50\" id=\"ff_5_input_text_50\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_51' id='label_ff_5_input_text_51' aria-label=\"Other income: $\">Other income: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_51\" class=\"ff-el-form-control\" data-name=\"input_text_51\" id=\"ff_5_input_text_51\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-5_9\" ><h4>Family Member's Information:<\/h4><\/div><div data-name=\"ff_cn_id_19\"  class='ff-t-container ff-column-container ff_columns_total_4 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_41' id='label_ff_5_input_text_41' aria-label=\"Wages: $\">Wages: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_41\" class=\"ff-el-form-control\" data-name=\"input_text_41\" id=\"ff_5_input_text_41\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_42' id='label_ff_5_input_text_42' aria-label=\"TANF: $\">TANF: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_42\" class=\"ff-el-form-control\" data-name=\"input_text_42\" id=\"ff_5_input_text_42\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_43' id='label_ff_5_input_text_43' aria-label=\"SNAP: $\">SNAP: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_43\" class=\"ff-el-form-control\" data-name=\"input_text_43\" id=\"ff_5_input_text_43\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-4' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_44' id='label_ff_5_input_text_44' aria-label=\"UI: $\">UI: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_44\" class=\"ff-el-form-control\" data-name=\"input_text_44\" id=\"ff_5_input_text_44\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_20\"  class='ff-t-container ff-column-container ff_columns_total_4 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_45' id='label_ff_5_input_text_45' aria-label=\"SSI: $\">SSI: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_45\" class=\"ff-el-form-control\" data-name=\"input_text_45\" id=\"ff_5_input_text_45\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_46' id='label_ff_5_input_text_46' aria-label=\"SSDI: $\">SSDI: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_46\" class=\"ff-el-form-control\" data-name=\"input_text_46\" id=\"ff_5_input_text_46\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_47' id='label_ff_5_input_text_47' aria-label=\"Survivors: $\">Survivors: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_47\" class=\"ff-el-form-control\" data-name=\"input_text_47\" id=\"ff_5_input_text_47\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-4' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_48' id='label_ff_5_input_text_48' aria-label=\"Retirement: $\">Retirement: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_48\" class=\"ff-el-form-control\" data-name=\"input_text_48\" id=\"ff_5_input_text_48\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_21\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_491' id='label_ff_5_input_text_491' aria-label=\"Child Support: $\">Child Support: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_491\" class=\"ff-el-form-control\" data-name=\"input_text_491\" id=\"ff_5_input_text_491\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_501' id='label_ff_5_input_text_501' aria-label=\"Veteran&#039;s Assistance: $\">Veteran's Assistance: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_501\" class=\"ff-el-form-control\" data-name=\"input_text_501\" id=\"ff_5_input_text_501\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_511' id='label_ff_5_input_text_511' aria-label=\"Other income: $\">Other income: $<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_511\" class=\"ff-el-form-control\" data-name=\"input_text_511\" id=\"ff_5_input_text_511\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-5_10\" ><p><em>If you have additional family members in your home, please include in Section VI.<\/em><\/p><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-5_11\" ><h3 class='ff-el-section-title'>Section V: Household Information<\/h3><div class='ff-section_break_desk'><p>List family members living in your home and any wage and benefit amount they\u2019ve received in the past six months:<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_description_1' id='label_ff_5_description_1' aria-label=\"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.\">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.<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_5_description_1\" name=\"description_1\" id=\"ff_5_description_1\" class=\"ff-el-form-control\" rows=\"10\" cols=\"2\" data-name=\"description_1\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Certification\">Certification<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_8a7266deb20283e3e6e62eb419d28929'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"I certify the following: I certify that the information provided is true to the best of my knowledge. I am also aware that the information I have provided is subject to review and verification and I may have to provide documents to support this application. I am also aware that I am subject to immediate termination if I am found ineligible after enrollment and may be prosecuted for fraud and\/or perjury. I allow release of this information for verification purposes and understand that it will be used to determine eligibility. I further certify that, to the best of my knowledge, no member of my immediate family is employed in any administrative or supportive function in the New River\/Mount Rogers Workforce Development Board or any agency or supported by the board. As used here, \u201cfamily\u201d means \u201ctwo or more persons related by blood, marriage, or decree of court, who are living in a single residence and are: (1) a husband, wife, and dependent children, or (2) a parent or guardian and dependent children, or (3) a husband and wife.\u201d\"  id='checkbox_2_8a7266deb20283e3e6e62eb419d28929' aria-label='I certify the following: I certify that the information provided is true to the best of my knowledge. I am also aware that the information I have provided is subject to review and verification and I may have to provide documents to support this application. I am also aware that I am subject to immediate termination if I am found ineligible after enrollment and may be prosecuted for fraud and\/or perjury. I allow release of this information for verification purposes and understand that it will be used to determine eligibility. I further certify that, to the best of my knowledge, no member of my immediate family is employed in any administrative or supportive function in the New River\/Mount Rogers Workforce Development Board or any agency or supported by the board. As used here, \u201cfamily\u201d means \u201ctwo or more persons related by blood, marriage, or decree of court, who are living in a single residence and are: (1) a husband, wife, and dependent children, or (2) a parent or guardian and dependent children, or (3) a husband and wife.\u201d' aria-invalid='false' aria-required=true> <span>I certify the following: I certify that the information provided is true to the best of my knowledge. I am also aware that the information I have provided is subject to review and verification and I may have to provide documents to support this application. I am also aware that I am subject to immediate termination if I am found ineligible after enrollment and may be prosecuted for fraud and\/or perjury. I allow release of this information for verification purposes and understand that it will be used to determine eligibility. I further certify that, to the best of my knowledge, no member of my immediate family is employed in any administrative or supportive function in the New River\/Mount Rogers Workforce Development Board or any agency or supported by the board. As used here, \u201cfamily\u201d means \u201ctwo or more persons related by blood, marriage, or decree of court, who are living in a single residence and are: (1) a husband, wife, and dependent children, or (2) a parent or guardian and dependent children, or (3) a husband and wife.\u201d<\/span><\/label><\/div><\/div><\/div><div data-name=\"ff_cn_id_22\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_input_text_52' id='label_ff_5_input_text_52' aria-label=\"Applicant&#039;s E-Signature\">Applicant's E-Signature<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_52\" class=\"ff-el-form-control\" data-name=\"input_text_52\" id=\"ff_5_input_text_52\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_datetime_5' id='label_ff_5_datetime_5' aria-label=\"Date\">Date<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime_5\" id=\"ff_5_datetime_5\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime_5\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_23\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_input_text_53' id='label_ff_5_input_text_53' aria-label=\"Parent&#039;s E-Signature if under 18\">Parent's E-Signature if under 18<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_53\" class=\"ff-el-form-control\" data-name=\"input_text_53\" id=\"ff_5_input_text_53\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_datetime_6' id='label_ff_5_datetime_6' aria-label=\"Date\">Date<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date Use arrow keys to navigate dates. 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