Green Cadre – Eligibility Form | Monterey County Workforce Development Board

Application Eligibility Date

Last 4 Digits of Your Social Security #(Required)

CONTACT INFORMATION

Name(Required)

First Middle Initial Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Phone Type

May we send you text messages?

Yes
No

Email(Required)

DEMOGRAPHIC INFORMATION

Date of Birth(Required)

Gender(Required)

Disability(Required)

If “Yes”, you will be required to complete a WIOA Disability Form at enrollment

Authorized to Work in U.S.(Required)

If U.S. Permanent Resident or Alien/Refugee:

Alien/Visa Registration #

Expiration Date

Hispanic Heritage(Required)

Race(Required)

EMPLOYMENT INFORMATION

Employment Status(Required)

If Employed, are you underemployed?

Unemployment Insurance Eligibility

Number of Weeks Unemployed

Current/Previous Hourly Rate

Occupation

EDUCATION INFORMATION

Currently enrolled in school(Required)

Highest Education Level(Required)

High School Diploma or Equivalent Received(Required)

PUBLIC ASSISTANCE

Temporary Assistance for Needy Families (TANF) – Recipient(Required)

Supplemental Security Income (SSI) - Recipient(Required)

General Assistance (GA)(Required)

Supplemental Nutrition Assistance Program (SNAP)(Required)

Social Security Disability Insurance Income (SSDI)(Required)

Receiving services under SNAP Employment & Training Program(Required)

Foster Child (state or local payments are made for applicant)(Required)

Youth currently living in high-poverty area(Required)

BARRIERS

English Language Learner(Required)

Basic Skills Deficient/Low Levels of Literacy(Required)

Homeless(Required)

Ex-Offender – individual has been arrested/convicted of a crime(Required)

Single Parent (including single pregnant women)(Required)

Cultural Barriers(Required)

FAMILY INCOME

Family Size(Required)

Past 6 months Family Income(Required)

APPLICANT CERTIFICATION STATEMENT

I certify that the information on this application is accurate to the best of my knowledge. I understand that my willful misstatement of the facts may cause my forfeiture of rights in the Green Cadre Program and may result in criminal action. I give permission for outside sources to be contacted and for them to disclose any information necessary to verify my eligibility for Green Cadre. I further understand and agree that my social security number and other information on this application will be provided to other government agencies as required by law.

Signature(Required)

Green Cadre Eligibility Form