Name* Date* MM slash DD slash YYYY Personal InformationAddress* Street Address Apt # City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneHomeCell*Email Address Date of Birth* MM slash DD slash YYYY Where do you live?* Apartment Mobile Home/Trailer House Shelter How long have you lived there?Years YearsMonths MonthsDo you have a driver's license?* Yes No Number* State* Are you a US citizen?* Yes No If no, do you have a green card? Yes No Are you a Veteran?* Yes No If yes, which branch of the US military? Marital Status?* Single Separated/Divorced Married Widowed Who lives in the same house with you?Name Age Relationship to you AddRemoveDo you personally have any form of income?* Yes No If yes, where does it come from?* Yearly Net Amount for you $* Total Yearly Net Amount for Entire Household $* Check each form of financial assistance that you and your family receive.* Free School Lunch Rent Assistance Social Security Disability Other What proof of household Income will you be able to provide?* Name of emergency contact* Phone number* Do you attend church/synagogue/mosque?* Yes No Worship Leader* Phone Number* How do you spend your free time? What do you enjoy doing?* Education & Work ExperienceWhat is the highest grade you completed?* Did you graduate from High School?* Yes No If you did not graduate, did you earn a GED? Yes No If no, do you plan to pursue your GED? Yes No What training programs have you attended or completed?Training Program Date(s) AddRemoveWhat skills do you have?* Where have you worked?Work Place Responsibilities Date(s) AddRemoveWhich of the jobs you’ve held was the most satisfying? Why?How did you hear about Christian Women’s Job Corps?* Job Fair Friend/Relative Church Tarrant County Workforce Solutions Women’s Shelter Mission Arlington Drove By Other What benefits do you envision by being involved in the CWJC program?Write one paragraph about one of the best experiences of your life, OR one of the worst experiences of your life.Christian Women’s Job Corps of Greater Arlington Consent, Authorization, and Release for Photograph* MM slash DD slash YYYY In promotion and publications of Christian Women’s Job Corps and WMU. I acknowledge that CWJC and/or WMU is the sole owner of this photograph (or photographs) in which I am included and can use it as well as any printed matter related to the photograph. I release Christian Women’s Job Corps and WMU and its legal representative from any legal responsibility related to the photograph in which I am included. I represent that I am 18 years of age and have the right to enter into this agreement. I consent to the use and copyright of photography in which I am included for use. Consent I consent to the release of photographEntering your name here serve as your signature. Christian Women’s Job Corps of Greater Arlington Participant Release Form* MM slash DD slash YYYY I wish to participate in Christian Women’s Job Corps, a ministry of WMU (hereinafter referred to as the “Program”). For and in consideration of my being allowed to participate in the Program and any related activities, and in consideration of my being allowed to use the facilities of “Sponsoring Organizations” (defined below), I, on behalf of myself, my heirs, distributes, guardians, legal representatives, personal representatives, and assigns, agree and covenant as follows: I will not make a claim against, sue, attach the property of, or prosecute any action against any “Sponsoring Organizations” of the Christian Women’s Job Corps, a ministry of WMU. Sponsoring Organizations include but are not limited to any participating church, association, or organization and their affiliates; and any of these entities’ employees, agents, servants, officers, directors, shareholders, successors, or assigns. This Release and Agreement includes and applies to any and all claims for any loss, injury, or damage related to or in any way arising from my participation in the Program and any related activities. I hereby release and further discharge the Sponsoring Organizations, including their volunteers, counselors, employees, agents, servants, officers, directors, shareholders, successors, or assigns, from any loss, injury, or damage resulting from any act and/or omission related to or in any way arising from the Program and any related activities. I understand and agree that the Sponsoring Organizations make no warranties, either express or implied, as to the character and fitness of any Participant in the Program. I agree to defend, indemnify, and hold harmless the Sponsoring Organizations, including their volunteers, counselors, employees, agents, servants, officers, directors, shareholders, successors, or assigns (hereinafter referred to collectively as the “Released Parties”), from and against any and all claims arising from my participation in the Program and any related activities. In the event a claim is made against any Sponsoring Organizations or any other Released Parties on account of my participation in the Program and any related activities, I agree to indemnify and defend the Sponsoring Organizations and any other Released Parties from any such claim, and further agree to pay all costs, expenses, and attorney’s fees incurred in the defense of the claim. I will also indemnify the Sponsoring Organizations and any other Released Parties for any judgments, awards, or settlements entered into or rendered on any such claim. I understand and agree that my obligations to defend, indemnify, and hold the Sponsoring Organizations and the other Released Parties harmless shall apply regardless of whether the loss, injury, or damage which the subject of the claim was caused, in whole or in part, by any act of omission of the Sponsoring Organization or any other Released Parties. I have carefully read this Release and Agreement and fully understand its contents. I am aware that this is a release of liability and a contractual agreement between me and the Sponsoring Organizations and the other Released Parties. I further acknowledge and represent that I have signed this Release and Agreement of my own free will. All understandings and agreements between me, the Sponsoring Organizations, and the other Released Parties are contained in this Release and Agreement. The terms of this Release and Agreement are contractual and not a mere recital. Consent I consent to the release formEntering your name here serve as your signature. NameThis field is for validation purposes and should be left unchanged.