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Job Training Services (WIOA) Application

Fill out the following form to apply for job training or work-related items assistance.

Step 1 of 11

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  • Please check to be sure you have selected the correct WIOA Service. To participate in the service you selected, you are required to watch an orientation. Please click the link below to begin the orientation.

    Click here to begin the Orientation

  • Please check to be sure you have selected the correct WIOA Service. To participate in the service you selected, you are required to watch an orientation. Please click the link below to begin the orientation.

    Click here to begin the Orientation

  • Contact Information

  • Name * Required
  • Date Format: MM slash DD slash YYYY
  • School Status * Required
  • Residence Address * Required
  • Is your mailing address different from your residence address? * Required
  • Mailing Address * Required
  • Contacts

  • Please list at least three people with whom you're frequently in contact.
    Name Phone Relationship  
         
    • Edit
    • Delete
    There are no Alternate Contacts.

    Maximum number of alternate contacts reached.

  • Qualifying Questions

    Please tell us more about your background so that we can best determine your eligibility for services.
  • Gender * Required
  • You must be authorized to work in the United States to participate in this program. What is your current status? * Required
  • Date Format: MM slash DD slash YYYY
  • Race/Ethnicity * Required
  • Have you register for selective service? * Required
  • Are you a veteran or currently in the military? * Required
  • Migrant Worker Status * Required
  • Do you have a criminal record? * Required
  • Do any of the following apply to you?
    Please select all that apply.
  • Have you received TANF? * Required
  • Please check any of the following that apply to your status as a TANF recipient
  • Education

  • Please select your schooling status * Required
  • Are you attending school full- or part-time? * Required
  • Have you participated in Job Corp.? * Required
  • Please describe any other specialized training that you have completed (military, vocational, etc.).
  • Military

  • Are you currently active duty in the military? * Required
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Discharge Type * Required
  • Release/Retire * Required
  • Check any that apply to your military service: * Required
  • Public Assistance

  • Please complete this section if you receive any of the following: TANF, SNAP, SSI, SNAP E&T ABAWD, SSDI, or any other public assistance currently or in the last 6 months.
    Type of Public Assistance HHSC Case Number HHSC Client Number Amount Received Start Date Certification Date Named or Grant? Currently Receiving? Last Payment Date  
                     
    • Edit
    • Delete
    There are no Entries.

    Maximum number of entries reached.

  • Family

  • Family Status
    Select all that apply.
  • Are you the head of your household with dependent children? * Required
  • Click the plus mark (+) to add additional rows. Add one row (and fill it in) for each family member in your household. Be sure to account for each member - the number of people listed should match the number of people selected in the dropdown above.
    NameRelationship to You 
  • Employment

  • Have you worked LESS THAN 3 months in the past year? * Required
  • Have you worked LESS THAN 3 months in the past 24 months (2 years)? * Required
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Dislocated Worker
    Please select any that apply to your current reason for being unemployed:
  • Disability/Medical

  • Do you have a history of substance abuse? * Required
  • Do you have a disability? * Required
  • Which type of disability? * Required
    Please check all that apply.
  • Review Application

    Please review the information you have submitted below for accuracy. If you need to make a change, you may go back by clicking the "Previous" button, below.
  • {all_fields}
  • Create Your Account

    Fill out the following fields to create your user account on the Workforce Solutions Panhandle Customer Portal.
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  • Certification

    I certify there is no intent to commit fraud. I am also aware that the information provided is true to the best of my knowledge and will be used to determine eligibility and that I am required to document the accuracy of the information and that the information is subject to external verification and may be released for such purposes. I am also aware that I am subject to immediate termination if I am found ineligible after enrollment as a result of falsifying information on the application and may be prosecuted for fraud and / or perjury.
  • This field is for validation purposes and should be left unchanged.
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  • Name * Required
Save and Continue Later
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Named or Grant?
  • Currently Receiving? * Required
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.