Microsoft Word Certification Application

Participant Application

Name
Address
Upload Photo ID(Required)
Accepted file types: jpg, jpeg, png, gif.
State ID, Drivers License, Matrícula Consular, or Passport
Race
Ethnicity
Disabled
Relationship Status
Annual Household Income
Currently Employed
Are there any circumstances in your life that might keep you from completing classes for 8 weeks?

Emergency Contact Information

Emergency Contact Name

Photo/Video Auth Release Consent

I hereby grant Christian Women’s Job Corps of Tyler, its legal representatives, agents, successors or assigns, permission to use my likeness in photographs, movie films, videotapes and/or sound records, or any part thereof in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of Christian Women’s Job Corps of Tyler and will not be returned. I hereby irrevocably authorize the Christian Women’s Job Corps of Tyler to edit, alter, copy, exhibit, publish or distribute the photographs, movie films, videotapes and/or sound records, for purposes of publicizing the Christian Women’s Job Corps of Tyler programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge Christian Women’s Job Corps of Tyler legal representatives, agents, successors or assigns, from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I am 18 years of age or older and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.
Do you consent to the photo/video consent policy?(Required)

Illegal Drug/Alcohol and Weapon Policy

Christian Women’s Job Corps of Tyler is a clean organization—no drugs, alcohol or weapons allowed. If a program participant or anyone brings nonprescription (not prescribed specifically for the participant), drugs, alcohol or weapons onto the premises or comes onto the premises under the influence of nonprescription drugs or alcohol or in possession of a weapon, that program participant or individual will be dismissed from the program immediately and asked to leave the premises. The Executive Director or an Officer of the Board of Directors may require drug testing at the expense of the participant, before re-admittance will be considered. Re-admittance to the program will be assessed upon the provision of documentation by the participant that she is drug/alcohol free.