Hold Harmless Statement

On behalf of myself and my dependents, I fully and forever release, discharge and hold harmless USA Cares and its directors, officers, employees, advisors, affiliates, fundraisers, donors, and sponsors of and from any and all claims, demands, actions, cause of action, suits, controversies and liabilities of every kind and nature accruing to me or my dependents or any other person arising directly or indirectly from or on account of, or otherwise related to, the activities and assistance of USA Cares.

I have read, and I accept all terms of the Hold Harmless Statement.

Non-Discrimination Policy

USA Cares does not and shall not discriminate on the basis of race, religion, sex, sexual orientation, national origin, age, disability, genetic disposition, or any other characteristic protected by law in any of its activities or operations. These activities include, but are not limited to, selection of volunteers and vendors, and provision of services. We're committed to modeling diversity and inclusion for the military community and the nonprofit sector, and to maintaining an inclusive environment with equitable treatment for all.

I have read, and I understand the Non-Discrimination Policy.

Electronic Services Informed Consent Statement

USA Cares utilizes interactive technologies that incorporate network and software security protocols to protect the privacy and confidentiality of client information transmitted via our Client Portal. These protocols include measures to safeguard the data and to aid in protecting against intentional or unintentional corruption. Some program services may be provided through interactive technologies, including but not limited to video, phone, text, apps, email, or other electronic means. Despite the benefits of these security measures, there are limitations associated with the use of electronic service delivery. I understand I will need access to, and familiarity with, the appropriate technology in order to participate in some USA Cares programs and services.

I have read, and I accept all terms of the Informed Consent Statement.

Application Agreements
Assistance from USA Cares is only available to post-9/11 veterans, active-duty service members, and their families, but being a post-9/11 veteran or service member does not automatically mean you are eligible for assistance. I understand I am not guaranteed assistance from USA Cares and, if I do not qualify for assistance, I will be provided with alternative resources.

The individuals, corporations, and foundations that fund USA Cares' assistance programs require that we share examples and testimonials from clients to whom we provide support. As an applicant, you understand that USA Cares may contact you to share your story. Your testimony can help USA Cares continue to receive funding, which will allow us to continue providing aid to other veterans and military families like yourself.

If not completed and submitted within ten days, my saved application may be deleted.

I have read, and I understand the above statements.

Contact Information

First Name

Last Name

Title/Salutation

Email Address

Enter ONE email address only. Entering multiple email addresses will cause the submission of your application to fail.

Phone - Home

Phone - Cell

Street Address

City

State

Zip

Last Four Digits of Service Member's SSN

NetExam User Type

NetExam Courses

Military Information

What is the expected date if your discharge? (mm/dd/yyyy format)

Branch of Military

Military Status

Component

Home of Record?

Military Occupation

Purple Heart Received?

Unit Assigned (If you are no longer serving, please enter N/A)

Are you currently employed?

Current Employer Information

Name of Current Employer

Employer's Address

Employer City

Employer State

Employer Zip

Start Month

Start Year

Current Job Title

Employment Status

Full TimePart Time

Current Hourly Rate

Does salary include a Bonus? If yes, please explain.

Brief Job Description

Previous Employment Information

Name of Last Employer

Job Title

Address Line 1

City

State

Postal Code

Date you were last employed, MM/DD/YEAR

Hourly Rate

Did your salary include a bonus? If yes please describe.

Brief Job Description

Education/Training Credentials

Education Level

Education Major

Name of School you are Attending? Do not answer if you are not attending.

Expected Graduation Date MM/DD/YEAR Do not answer if you are not attending school.

Technical Training Courses Awarding a Professional Certificate

Employment Considerations/Restrictions

VA Rating Status

What is the status of your VA Rating? Yes means you have a status. No means you do not have a status. Pending means your status is being evaluated. Unknown means you do not know the status.

VA Rating %

Do you have a criminal record or credit issues that may impact your background check?

NoYes

If you checked yes to "do you have a criminal record or credit issues that may impact your background check," please describe them here:

Are you willing to relocate for employment?

Desired Location (City, State)

Miles willing to travel

Percentage of time you are willing to travel daily one way

Start date availability MM/DD/YEAR

Desired Salary (Hourly)

Have you completed an employment screening assessment? If yes, please select all completed.

Hold down the command / ctrl key to select multiple choices.

Other:

Are you receiving Vocational Rehabilitation?

Do you have employment restrictions?

Are you willing to retrain?

Additional Information

Please Note: The following information is for demographic/internal use only and will not affect the outcome of an application.

Race

Race if "Other"

No more than 50 characters, including spaces.

Service Member Age

Gender

Marital Status

Total members of Household

How did you hear about us?

Please tell us where you have heard about us. You may select more than one.

Contact Information