STUDENT & YOUNG ADULT INFORMATION FORM

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Name:
Address:
City, State Zip:
Phone:
Email (if available):
Are you over the age of 18 and eligible to work in the United States?     Yes     No
  If “No”, provide your age:
Do you have a valid Florida Driver’s License?     Yes     No
 
Do you have reliable Transportation?     Yes     No
 
Gender:     Male     Female
 
Please share your race and ethnicity so that FDOT can continue to receive funding from the Federal Highway Administration to provide this free service. Select all that apply:
Black/African American     Asian     Hispanic/Latino/Spanish     Middle Eastern     American Indian
Pacific Islander     White     Other
Primary language:   English     Spanish     Other
 
In which Florida county do you live?  
 
How did you hear about the Statewide Workforce Development Program?
Which Statewide Workforce Development Programs for students and young adults are you interested in? Select all that apply:
Construction Career Days    
Student Construction Career Academy
Student Construction Internship Program    

Education
High School (Name and City/State of School):
College (Name and City/State of School):
Other:

Type(s) of work you’re interested in (List all that apply):
Skills:

If you have a previous employment history, please provide the following information:
Employer:
Location:
Position Title:
Dates of employment:
From:     To:
Responsibilities:

Previous Employment 2
Employer:
Location:
Position Title:
Dates of employment:
From:     To:
Responsibilities: