Lumity's Illinois Works Pre-Screen Application

Question Title

* 1. Please provide us with your contact information

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. What is your interest in the construction industry? (e.g. carpentry, electrical, plumbing etc.)

Question Title

* 3. The program takes place Tuesday - Thursday from 5PM - 9PM, can you commit to attending all classes during these days and times?

Yes

No

Other (please specify)

Question Title

* 4. Are you at least 18 years of age?

Yes

No

Question Title

* 5. Are you an Illinois Resident?

Yes

No

Question Title

* 6. Can you provide proof of State Identification/Matricula ID?

Yes

No

Question Title

* 7. Can you provide proof of Birth Certificate?

Yes

No

Question Title

* 8. Do you have a High School Diploma or GED?

Yes

No