CITC DWG Career Application

Education
Are you currently attending school?*

YesNo
Highest Grade completed (0-12)?*
Highest Educational Level Completed at Program Entry:*
School Status*
How well do you speak English?

BeginnerIntermediateProficient
Do you have limited proficiency/difficulty speaking, writing, reading, or understanding English?

YesNo
What is your primary Language?
Do you require English language assistance?*

YesNo

Applicant Certification

Please write your initials next to each statement.
Initials* I certify to the best of my knowledge the information in this application is accurate, true, and verifiable, and subject to verification.
Initials* I understand that the in the answers I have provided in this application are considered self-attestation and may I be asked to provide proof to support my answers.
Initials* I understand that falsification of information to receive grant benefits may be grounds for removal from the program, and/or I may have to repay benefits received.
Applicant's Signature*

Clear
Date

MonthDayYear
Today's Date*

MonthDayYear
Date
Service Department
Should be Empty:

Military