Highway Construction Careers Training Program (HCCTP) Application

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Cell Phone *

County of Residence *

Email *

Email

Confirm Email

If you have a disability requiring special attention, please describe

Date of Birth *

Gender *

Marital Status *

Do you have a valid driver’s license? *

Type of License

State of Issuance

U.S. Citizen *

Ethnic Background *

If you chose "Other" please put your ethnic background here

Education

Check which of the following that you have obtained (Diploma, Degree, etc.) *

If indicated above, what field is your Degree, Certificate/License in

Are you presently in school or an educational program? *

If you chose "Yes" please put the name of school or program here

Have you participated in other training programs? *

If yes, for how long

Type of training

Have you ever participated in the HCCTP? *

If Yes, Where

Did you complete the program?

If no, state reason why

Employment History

What is your current employment status? *

Indicate your current occupational field or job title

List any other jobs held or work performed that may be related to the Construction Industry

The Following Income Information is Voluntary:

What is your current household income level?

Indicate the number of dependents under the age of 18 living with you in your household

Indicate the TOTAL number of occupants in your household

List Sources of Income

Felony Record

Have you ever been convicted of a felony or misdemeanor? *

If yes, what was the conviction charge and date?

Contact Information

Please list (2) reliable contacts.

Name *

First

Last

Relationship *

Phone *

Name *

First

Last

Relationship *

Phone *

Essay Question

Please explain, in detail, why you should be the selected candidate for this program and why? *

NOTICE OF CERTIFICATION

NOTICE OF CERTIFICATION *

NOTICE OF CERTIFICATION: I understand that to be eligible to participate in this program, the participant must be: 1) 18 years of age, 2) Possess a valid driver’s license and 3) Have a high school diploma or GED. I understand that participation may be contingent upon satisfactory results from drug screening. I understand and agree that the information I have provided is accurate to the best of my knowledge with no intent to commit fraud. Any misrepresentation or deliberate omission may be grounds for termination from this program. I understand that this information will be kept confidential and will not be released to the public. I have been advised that this information will be kept on file for 1 year and may be shared with other authorized agencies for the purpose of administering programs of these agencies. I understand that I have the right to inspect this information and initiate appropriate corrections through the agency to which I am providing this information. NOTICE: The Illinois Dept. of Transportation, the Illinois Community College Board and the participating community colleges do not guarantee employment upon a trainee’s graduation from the Highway Construction Careers Training Program.

HCCTP APPLICATION QUESTIONNAIRE

List what you currently know about the HIGHWAY CONSTRUCTION Industry. This includes such things, as the nature of the work, different crafts involved, working conditions, tools and equipment used, pay rates, etc. *

Give any work experience that relates to the Construction Industry. This can also include such things as minor repairs to a home, use of hand tools, servicing your car, etc. *

From the following list of documents, please indicate which documents you have or can obtain. Some documents are mandatory for the HCCTP Program that you are applying for and will be marked as mandatory.

Check those that you have or can obtain *

HIGHWAY CONSTRUCTION Industry job sites are hot in the summer and cold in the winter. Work is seasonal, usually lasting from the end of April to the middle of November with conditions and language sometimes being rough. Having to get up as early as 4:30 a.m., traveling for an hour and working 10–12 hour days is common. List what experiences, if any, that you have working in similar situations or why you would want to work in these conditions.

List what experiences, if any, that you have working in similar situations or why you would want to work in these conditions. *

Showing up each day and on time is a priority in the HCCTP. The program that you are applying for has strict attendance policy guidelines. Missing class, being tardy and/or leaving early can and will lead to expulsion from this class. List below what means of transportation you have and, if applicable, what childcare and other arrangements you have or will make to ensure that you will be able to meet these attendance guidelines.

Transportation

Childcare/Other

Give your specific reasons for wanting to enroll in this class. List what you want to accomplish during and after the course is over. *

Finally, as far as consideration for this program, is there anything else you would like to tell us about yourself?

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Center for Workforce Development

Center for Workforce Development

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