WorkTexas Intake Application
Welcome to the WorkTexas Intake Application!
If you would like to read this application in a different language, please select one from the list below.
To sign up for WorkTexas training, you will need to complete the following steps:
Complete the Intake Application
Attend an Information Session
Get Screened for Eligibility
Attend Ganas Boot Camp
Review your application before you submit it. If you leave the form idle for more than 20 minutes, your session will expire and you will have to start over!
Acknowledgement
WorkTexas offers training programs designed to prepare participants for
employment
. These programs involve focused learning followed by active job search efforts.
By clicking yes below you
acknowledge
that you are interested
in pursuing
training for employment or career advancement purposes. By clicking no, you understand that WorkTexas is not the most
suitable training environment. Please feel free to reapply when you are seeking training for employment or career advancement purposes.
Yes
No
Reason for Applying
What is the primary reason you are interested in enrolling in training at WorkTexas?
To gain skills that can help me get a job.
To gain new skills that I can utilize at my current job.
To gain skills that will help me get a better job or advance in my career.
Personal Information
First Name
Middle Name
Last Name
Last Name Suffix
Date of Birth
Contact Information
Cell Phone Number
Alternate Phone Number
WorkTexas uses text messaging to keep you informed. Check to opt in.
Yes, sign me up for text messages.
Email
name@domain.com
Please confirm your email
name@domain.com
Email Message
Address Line 1
Address Line 2
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
County
Please select...
Austin
Brazoria
Chambers
Colorado
Fort Bend
Galveston
Harris
Liberty
Matagorda
Montgomery
Walker
Waller
Wharton
Page 2
Demographic Information
Gender
Male
Female
Other
Ethnicity/Nationality
Asian
Black / African American
Hispanic / Latino
Middle Eastern / North African
Native American / Alaskan Native
Native Hawaiian / Pacific Islander
White
Mixed Race
Other
Income
Less than $14,580 per year
Less than $24,000 per year
Between $25,000 - $35,000 per year
Between $36,000 - $42,000 per year
Greater than $42,000 per year
What is your household size (including you)?
Yes
No
Are you a recent immigrant?
Are you a refugee or internally displaced?
Primary language spoken
English
Spanish
Other
Are you bilingual?
Yes
No
Which languages do you speak?
English
Spanish
Arabic
Hindi
Vietnamese
Portuguese
Yoruba
Ibo/Igbo
Swahili
French
Other
What is your T-Shirt Size?
Small
Medium
Large
XL
XXL
XXXL
Page 3
Education
Are you currently attending school?
I am currently attending school.
I am NOT currently attending school.
What is the highest level of education completed?
GED
High School Diploma
Associate's Degree
Bachelor's Degree
Master's Degree
Doctoral Degree
Degree From Another Country
None
Criminal Background
Having a criminal background does not affect your ability to participate in our trainings.
If you have a background that includes: a
felony within the last 5 years OR misdemeanors within the last 3 years OR any sexual or violent crime ever, eligibility will be
dependent on employer requirements.
Do you have a criminal background?
Yes
No
If yes, what was the offense?
Date of Offense
Do you agree to a background check?
Note: By checking this box, you allow the WorkTexas team to conduct a background check.
Yes
No
Drug Free Policy
WorkTexas is a Drug-Free training facility and the expectation for students is that they remain drug-free, especially because our focus is employment. By clicking yes you acknowledge the understand of this policy.
Yes
No
I9 Documents
Please upload a copy of your State ID or Driver's License
Please upload a copy of your Social Security Card
Page 4
Resources
Please select the type of assistance you need that will allow you to be successful in training. Check all that apply.
Childcare
Clothing
Financial Coaching
Food
Health Needs
Education (High School Diploma or GED)
Housing (Homeless)
Job Training/Employment
Medication Needs
Mental Health Needs
Prenatal Care
Transportation
None
Please select the type of insurance you currently have:
Private
Medicaid
Medicare
CHIP
CHIP Perinatal
None
Other Insurance Type
Other Insurance Type
If you have Medicaid, which type of Medicaid do you have?
Please select...
United Healthcare
Molena
Community Health Choice
AmeriGroup
Texas Children's Health Plan
Traditional Medicaid
Do you have insurance through Community Health Choice?
Yes
No
Community Health Choice Member Full Name
Community Health Choice Member ID
Page 5
Screening Questionnaire
The answers to the next set of questions are used to predetermine any potential scholarships and funding opportunities for you. The answers DO NOT affect your ability to move forward with the enrollment process for our trainings.
Yes
No
Are you authorized to work in the United States?
Do you speak, read, write and understand the English language?
Are you currently enrolled in High School?
Are you or have you ever been in the foster system?
Are you pregnant or expecting a child?
Are you a parenting youth (between the ages of 16 - 24)?
Are you homeless, "couch surfing", or a runaway?
Have you been involved in the justice system?
Do you have or have had an incarcerated parent?
Are you or have you been a victim of human trafficking?
Do you have a disability?
Are you or anyone in your household currently receiving or (within the last 6 months) received SNAP or TANF benefits?
Is anyone in your household eligible to receive free or reduced lunch?
If not working, were you terminated or laid off AND eligible for OR exhausted Unemployment Insurance benefits?
Are you currently receiving unemployment insurance benefits?
Have you been unemployed for the last 26 weeks (6 months)?
Are you a veteran of the United States?
Is your spouse a veteran of the United States?
Page 6
Referral Information
How did you hear about WorkTexas?
Please select...
Avenue 360
City of Houston
Combined Arms
Community Health Choice
Community Preschools
Eastex-Jensen Classical Academy
Gallery Furniture/Mattress Mack
Greater Houston Builder's Association
Harris County Juvenile Probation
Hope and Healing Center Institute
Houston Community College
Houston Food Bank
Houston Threads
Journey Through Life
Legacy Community Health
Lonestar College
Lonestar Legal Aide
Main Street Ministries
Memorial Assistance Ministries
Neighborhood Schools
Northwest Assistance Ministries
Premier High School
Project Remix
Social Media
Wesley Community Center
Westchase Classical Academy
WorkFaith Connection
Workforce Solutions
WorkTexas Website
Other - Please type in your referral source if not listed here
Other - Referral Source
Sign Up for an Information Session
Your next step is to attend a mandatory Information Session. During the Information Session, you will learn more about our training programs, career pathways and the WorkTexas training model. For your convenience, we offer Information Sessions and trainings at two locations.
Tuesdays at 5:30 pm: The Opportunity Center, 6500A Chimney Rock, Houston, Texas 77081.
Thursdays at 5:30 pm: WorkTexas - Gallery Furniture, 6006 North Freeway, Houston, Texas 77076.
Please select the next available date for Information Session:
Preference
Please select...
Building Maintenance
Carpentry
Child Development Associate
Commercial Driver's License
Commercial Electrical
Computer Literacy Classes
ESL (English as a Second Language)
GED
HVAC
Masonry
Plumbing
Residential Electrical
TIG Welding
Welding I
preferencelocation
The Opportunity Center
Tuesdays at 5:30 pm: The Opportunity Center, 6500A Chimney Rock, Houston, Texas 77081.
date for sorting
The Opportunity Center, 6500A Chimney Rock, Houston, TX 77081, Tuesday, 10/29/2024 5:30 PM
Gulfton Count
Campaign Id
date for sorting
The Opportunity Center, 6500A Chimney Rock, Houston, TX 77081, Tuesday, 11/5/2024 5:30 PM
Gulfton Count
Campaign Id
Gallery Furniture
Thursdays at 5:30 pm: WorkTexas - Gallery Furniture, 6006 North Freeway, Houston, Texas 77076.
date for sorting
Gallery Furniture, 6006 North Freeway, Houston, TX 77076, Thursday, 11/7/2024 5:30 PM
Gallery Count
Campaign Id
Total Count
You can only register for one info session.