ACE Program Survey
The following screening assessment is used to review your eligibility and suitability for the ACE Program.
*
1.
First Name:
(Required.)
2.
Middle Initial:
*
3.
Last Name:
(Required.)
*
4.
Full Social Security Number:
(Required.)
*
5.
Date of Birth:
(Required.)
*
6.
Physical Address:
(Required.)
*
7.
County of Residence:
(Required.)
*
8.
City:
(Required.)
*
9.
State:
(Required.)
*
10.
Zip code:
(Required.)
*
11.
Personal email:
(Required.)
*
12.
Phone number:
(Required.)
*
13.
Alternative phone number:
(Required.)
*
14.
Please choose the training program you are interested in: (Please visit our website for program descriptions)
(Required.)
Digital Marketing (8 weeks)
Front-end Web Development (10 weeks)
Cybersecurity Specialist (10 weeks)
Help Desk, IT Support Technician (10 weeks)
Intro to Green Construction (10 weeks)
Phlebotomy (10 Weeks)
*
15.
Have you registered in EmployFlorida.com? Go to this page to register; https://www.employflorida.com/vosnet/Default.aspx
(Required.)
Yes
No
*
16.
Are you a U.S. Citizen or legally authorized to work in the U.S.?
(Required.)
Yes
No
*
17.
All males born January 1, 1960 or later are required to register with Selective Service. If applicable, have you completed this registration? To check your registration please visit sss.gov.
(Required.)
Yes
No
N/A
*
18.
Do you consider yourself to have a disability?
(Required.)
Yes
No
I do not wish to answer.
*
19.
Are you in the military, an eligible veteran, or spouse of an eligible veteran?
(Required.)
Yes
No
*
20.
Are you currently Active Duty military spouse who is unemployed/underemployed?
(Required.)
Yes
No
*
21.
Are you currently working?
(Required.)
Yes
No
22.
Rate of pay?
23.
How many hours do you work per week?
*
24.
Are you able to work full-time?
(Required.)
Yes
No
*
25.
Have you been convicted of a Felony
(Required.)
Yes
No
26.
If yes, please list year and location of conviction.
*
27.
Are you pregnant or have a dependent child?
(Required.)
Yes
No
*
28.
Do you currently reside in a homeless shelter or are you currently homeless?
(Required.)
Yes
No
*
29.
Are you currently in school?
(Required.)
Yes
No
30.
If applicable, what type of school are you currently in?
High School
Technical Training School
GED Preparation School
Other (please specify)
*
31.
Do you have a high school diploma?
(Required.)
Yes
No
32.
Have you completed any advanced training? Please list type and training and dates.
*
33.
Do you currently receive or are a member of a household family that receives Food stamps or received Food stamps during the previous six months?
(Required.)
Yes
No
*
34.
Are you currently receiving TANF/Cash assistance?
(Required.)
Yes
No
*
35.
Are you currently in foster care or aged out of foster care?
(Required.)
Yes
No
*
36.
What is your family size? (This includes the total number of people in your family= all individuals in your household related by blood, marriage or court decree.)
(Required.)
*
37.
What is your total annualized household income before taxes? (Family income = all those living in a household related by blood, marriage or court decree.)
(Required.)
*
38.
Do you file taxes by yourself or with your parents?
(Required.)
By myself
With my parents
With spouse
Other (please specify)
*
39.
Do you provide 50% or more of your living expenses?
(Required.)
Yes
No
*
40.
Type of income? (Please select all that apply)
(Required.)
Employment Wages and Salaries
Net receipts from self-employment
Pension or retirement income
Re-employment Assistance formerly called Unemployment Compensation
Child Support
Social Security Benefits
Strike benefits from Union funds
Net rental income
Alimony
Educational assistance or training stipends
Other support from a family member/friend not living in the household
Other income considered reportable to the IRS
*
41.
Do you use tobacco products, such as cigarettes, cigars, or chewable tobacco?
(Required.)
Yes
No
*
42.
If yes to question 41, would you like information on free products and support to help you quit smoking?
(Required.)
Yes
No
N/A
*
43.
Do you have reliable transportation to attend school and/or your worksite?
(Required.)
Yes
No
N/A
44.
What is your method of transportation? (select on or more of the following)
My own car
Friends or family car
Bus
Need transportation assitance
Other (please specify)
*
45.
Are you able to commit and go to school 2 days per week and work at an ACE worksite 3 days per week for up to 40 hours per week?
(Required.)
Yes
No
*
46.
Are you able to work 40 hours per week during your ACE experience which will be 8 to 12 weeks long?
(Required.)
Yes
No
*
47.
Are you able to maintain excellent attendance during your ACE training to both school and work?
(Required.)
Yes
No
*
48.
Do you have a laptop or access to a computer to take online training or virtual work?
(Required.)
Yes
No
*
49.
Do you have internet access where you will complete online training or virtual work?
(Required.)
Yes
No
*
50.
ACE program will upskill you to begin a career path in an demand occupation. Do you agree to seek and obtain employment at the end of your ACE experience?
(Required.)
Yes
No
*
51.
What type of employment are you looking for at the end of ACE?
(Required.)
*
52.
Will you need assistance with a resume and placement at the end of your ACE training through the ACE recruiter?
(Required.)
Yes
No
*
53.
During intake, your application and preparation to start the ACE program, you will be required to participate in the following:
· Complete application and eligibility
· Complete assessments such as Wonderlic and Digital Literacy testing
· Attend CSHP workshops to prepare for your worksite and/or training?
· Maintain monthly or biweekly contact with your ACE coach?
· Maintain good attendance in both classroom and worksite training?
Will you be able to complete these tasks?
(Required.)
Yes
No
