Good Jobs Challenge Application

Applicant Information

Today's Date:

First Name:

Middle Initial

Last Name:

Date of Birth

Telephone:

Email:

Reservation

County

Other Reservation:

Other County:

Physical Address

City

State

Postal Code

Are you a veteran?

YesNo

Which program are you applying for?

Construction Internship ProgramContractor Capacity BuildingInternational Code Council Residential Inspection Certification Training

CCB Application Information

Have you participated in a Coalition Event Before?

YesNo

Organization Name

Organization Size

Job Title

CIP Application Information

What site would you like to work at?

Cheyenne RiverCrow CreekPine RidgeRosebud - S.W.ASissetonYankton

Do you have any prior work experience?

YesNo

If yes please describe

Prior work experience 1:

Prior work experience 2:

Prior work experience 3:

Why are you interested in participating in the summer internship program?

What are your plans after completing the internship?

What construction trade would you like to specialize in?

ElectricalGeneral ConstructionFlooringIndustrial ConstructionPaintingPlumbingRoofingSidingWindow Installation/ReplacementOther

Please explain other construction trade of interest:

Do you anticipate any obstacles to your participation in the program this summer?

YesNo

Please describe:

How will you overcome these obstacles?

How do you plan to get to your internship site this summer? (your car, friend's car, relative's car, etc.)

If this ride falls through, what is your back-up?

Do you have tools and work gear?

YesNo

Please describe:

Please provide the name and contact information for one reference.

Name:

Phone:

ICC Questions

Have you set-up your ICC account yet?

YesNo

Do you have a laptop you can bring with you to training?

Yes, I have a laptop I can bring.No, I do not have a laptop I can bring. I would like to have one provided, if possible.

Which option best describes your comfortability with computers?

Very ComfortableComfortableNeither Comfortable nor UncomfortableUncomfortableI do not know how to use a computer.

Mailing Address (If different from Physical Address. We will use this for sending training materials.)

City

State

Postal Code

Additional Questions

If accepted, will you commit to completing a short, follow-up survey 6-months after completion of the program?

YesNo

Do you have any additional comments that you'd like to add?

Contact Information