test-form - Team Up Academy

Automotive & Industrial Boot Camp Application Form [updated]

For the 30-day Automotive & Industrial Boot Camp | Updated form to correct telephone field issues

"*" indicates required fields

1Part 1 - Applicant Details

2Part 2 - Education & Employment

3Part 3 - References & Contacts

4Part 4 - Declaration & Consent

Our 30-Day Boot Camp program follows a Lifeline for Success approach, placing an emphasis on training, employment, mentorship, and achieving success. Participants will gain the tools and back up they need to be successful and prosperous members of the community- while being prepared for long-term employment in the Automotive and Industrial industries.

Applicants Must Meet All the Following Requirements:
• Are 18 year or older
• Are High School Graduates
• Have an interest in learning about the Automotive or Industrial Industries
• Committed to attending to the full 30-day Boot Camp held Monday - Friday 8am - 4pm

Applicant Requirements*

I confirm that I meet all of the stated requirements.

Part 1 - Applicant Details

Your Name*

First Middle Last

Sex*

Date of Birth*

MM slash DD slash YYYY

Race*

Driver's License Number*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address*

Phone*

Mobile*

Do you have any previous experience in the Automotive or Industrial Industries?*

Yes

What is the name of the company?*

Are you applying as part of a school, college, community group, or similar?*

Yes

what is the name of the school, college or community group?*

Have you been in the military, or are you a veteran?*

Yes

Do you have reliable transportation?*

Yes

Have you had contact with the criminal justice system?*

Yes

Please tell us about it in detail*

Do you have a disability?*

Yes

Please tell us about your disability or impairment and how it affects you (to help us to understand how to support you)*

Do you have any conditions that may need special attention during the 30-Day Boot Camp?*

Is there anything else about your disability or impairment that we should be aware of, to help us to improve your learning/training experience?

Please tell us why you are interested in the 30-Day Boot Camp and how you believe it will benefit you.*

Part 2 - Education & Employment

Are you currently in school?*

Yes - High School

Yes - Post-Secondary School (Vocational school, college, etc.)

No - High School Graduate or Equivalent

No - Dropped Out

What is your highest degree or level?*

No School Completed

Grade (Write 1 through 11)

12th Grade- No Diploma

Diploma or equivalent

Post-Secondary Technical or Vocational Certificate

Some College, No Degree

Associate degree (AA, AS)

Bachelor’s Degree (BA, BS)

Degree Beyond Bachelor’s (MA, MS, PhD)

What is your current employment status*

Working Full Time

Working Part Time (less than 32 hours)

Not Working

Never Worked

Other (such as working as a contractor or temporary employee)

Part 3 - References & Contacts

Please list three professional references not related to you, with full name, phone number, and relationship*

Click the + sign at the end of each reference to add another row. (max 3)

Name

Phone Number

Relationship

Years Known

Emergency Contact Name & Relationship to Applicant*

It is important that we know who to contact in case you are injured or become unwell. By adding contact information below, I confirm that I have the consent of the person(s) below, to be contacted in an emergency during the course of Team Up Academy’s 30-Day Boot Camp activities. Click the + sign at the end of each reference to add another row. (max 2)

Name

Phone Number

Relationship

Part 4 - Declaration & Consent

I wish to apply to Team Up Academy’s 30-Day Boot Camp as a participant and confirm that all details given on this application are true and accurate, to the best of my knowledge.*

I agree

I agree that should Team Up Academy require additional information on my medical condition at any time, I will provide what is needed and will be willing to obtain a medical report from a medical professional, if necessary, who is familiar with my condition/s. I understand that I may be required to pay a fee for such a report.*

I agree

I confirm that I will notify Team UP Academy immediately if any of the details or information provided on this application should change in any way.*

I confirm

I recognize that the 30-Day Boot Camp activities involve risk, and that I, the participant, must take all reasonable precautions and follow all safety advice properly given, at all times.*

I confirm

Photo / Video Consent*

I give my consent to photographs or videos of me being taken during 30-Day Boot Camp activities for training and/or publicity (including, but not limited to, websites, social media, newsletters, and marketing materials for Team Up Academy). I give this consent understanding that these images will not be given to a third party without my explicit consent.

Yes

Information Accuracy & Background Authorization Acknowledgement

By signing below, the applicant grants permission to Team Up Academy to conduct a background check. I am aware that any falsification made in line with this authorization and my participant application shall become a bar for acceptance into the program.

I authorize that any information acquired by Team Up Academy shall solely be used for this application, and the information obtained through the background check will only be used to determine whether the results bear the trustworthiness of the application.

Applicant Signature*

Signed Date*

MM slash DD slash YYYY