RACEJT Application

SECTION 1: PERSONAL INFORMATION
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
This question will help identify additional funding sources if needed. If you are Alaska Native, what is your Regional Nonprofit Association?*

If not applicable to you, type in n/a.
Email*
Phone*
Best Time to Contact*
Preferred Contact Method*

SECTION 3: AVAILABILITY TO PARTICIPATE
Are you available for training in Anchorage March 31 – May 9, 2025*
You must be available to attend all classes of the training program

SECTION 4: EDUCATIONAL BACKGROUND
To be accepted to the 2025 program, you must have a high school diploma or GED by December 8, 2024
Did you graduate High School?*
If no, list the highest grade completed:
Do you have a GED?*
If yes, when did you received it?*
MM slash DD slash YYYY
Have you attended other educational institutions or training programs since school?*
If yes, please list the name, type of training, and years attended.*

SECTION 5: CONVICTION RECORD
Persons with criminal records are eligible for this training. However, your future employer must be made aware of previous criminal convictions. We will be conducting background checks through the Alaska Dept of Public Safety. You must first disclose here any prior convictions of violent crimes and provide an explanation. Please note we will not accept anyone who we determine to be a safety threat to other participants.
Have you been convicted of a violent crime (violent crimes include molestation or sexual crime)?*
If yes, please explain and give the date(s) of conviction:

SECTION 6: EMPLOYMENT STATUS AND WORK HISTORY
Are you currently unemployed?*
Are you currently underemployed (work less than 20 hrs/week total)?*
Please fill out your work history below, including volunteer jobs. If you would like us to know about more than your most recent 3 jobs

SECTION 7: FUTURE EMPLOYMENT
Having a potential job lined up is not a requirement, but it will give you priority during the selection process. If you have a potential job, your future employer must either participate in the screening interview OR provide a letter stating their commitment to hire you. The letter must be received by December 8, 2024
Do you have a potential employer if you are able to complete the training?*
What is the name of the company, organization, or government that you are seeking employment with?*
Contact Name, Address, & Phone or E-mail of Future Employer:*
Please provide a description of the job you will be performing*

SECTION 8: QUESTIONS FOR EMPLOYED APPLICANTS ONLY.
Check the boxes that apply to you.*
- I am employed in a position(s) for less than 20 hours a week year-round total.
- I am employed a total of 1040 hours or less in one calendar year.
- I am employed, but will lose my job before January 15th, 2025
- None of the above, but I have reason to believe I might still be program-eligible because (fill-in):
I might still be program-eligible because (fill-in):*
Will your current employer increase your wages or number of hours if you complete this training?*
Note if you checked “yes”, you will receive priority in the selection process if you submit a letter from your employer confirming the accuracy of this statement, or if your employer phones us or attends your interview.

SECTION 9: PERSONAL REFERENCES
You must have two people submit directly to us personal reference forms. Online reference form available at: https://zendergroup.org/racejt-cs-application-referral/
Did you arrange for two people who know you to fill out the online reference form?*

SECTION 10: HEALTH QUESTIONS
This program trains workers who may be required to do manual labor or may have to wear respirators (facemasks) and heavy enclosed clothing for their job. For most of the potential jobs for which you are being trained, you must be able to lift repeatedly and routinely 15 – 25 lbs. If you have a beard you must shave it for any respirator fit test. Good physical health is essential for this line of work. If you have health limitations, but your future employer is aware of them, we ask that you provide a letter from your future employer to excuse you from the fit test portion of the training. Please note that we will accommodate anyone with a disability(s) that does not affect performance of the essential functions of the jobs for which you are being trained.
Do you have any health problems or disabilities that would prevent or keep you from completing this training?*
Please explain*

SECTION 11: TRANSPORTATION, LODGING, AND MEALS
I have contributed to Unemployment Insurance (UI) benefits in Alaska or another state with similar provisions at least once in the last five years.
If you checked “yes” to #1, and are accepted to the program, can you provide documentation such as a past W-2, pay stub, UI statement, or other official document that demonstrates contribution to UI?
We can help you in locating an acceptable document

SECTION 12: CERTIFICATION
Please fill in your name and carefully read the following statement before signing.
I understand that there is zero tolerance for non-prescription drug and alcohol use at any time during my stay in Anchorage as a RACEJT participant, this includes travel to and from the program. I understand this program requires that I will agree to random breathalyzer tests.
I understand that appearing intoxicated, causing disruption of instruction, or negatively impacting others’ well-being, will result in removal from the training. I understand that this program may choose to perform random breathalyzer testing at any time and may choose to test those that are late to class or exhibit signs of being intoxication. I understand that failure to complete this training program may result in the reimbursement of the cost on my part to the entities that have provided for me. Failure to comply with any of these terms will result in termination from the program.
I understand that this program requires that I commit to the entire training to be accepted, including the CS program as appropriate.
Name*
First Last
Signature*
Date Signed

SECTION 1: PERSONAL INFORMATION