Please be sure to follow up with us to make sure we have received the materials you are submitting. You can contact Eric Pferdekamper at 412-745-1014. When you leave a message, please make sure you leave your first and last name, phone number, and reason for calling.

Personal Information

First Name

Middle Name

Last Name

Street Address

City

State

Zip

Date of Birth

Cell Phone

Home Phone

Work Phone

E-mail address

Are you registered with selective services?

Yes No

Are you authorized to work in the U.S.?

Yes No Rather not say

Who referred you?

May we share information about your application/enrollment with the referral source you listed?

Yes No

I have state issued I.D. and I am eligible to be present in a public school environment (EWCTC students only).

Yes No Rather not say

Employment History

Please list your last three employers. Start with your present or most recent employer.

Employer #1

From (Month, Year)

To (Month, Year)

Employer Phone

Position Held

Hourly Rate

Reason for Leaving

Employer #2

From (Month, Year)

To (Month, Year)

Employer Phone

Position Held

Hourly Rate

Reason for Leaving

Employer #3

From (Month, Year)

To (Month, Year)

Employer Phone

Position Held

Hourly Rate

Reason for Leaving

Education / Military Experience

Please provide as much information as possible.

High School Name

From (Year)

To (Year)

Did you graduate?

Yes No

Location (City/State)

List Math, Science, Industrial Arts, or similar courses completed

College Name

From (Year)

To (Year)

Did you graduate?

Yes No

Location (City/State)

List Math, Science, Industrial Arts, or similar courses completed

Trade or Business School Name

From (Year)

To (Year)

Did you graduate?

Yes No

Location (City/State)

List Math, Science, Industrial Arts, or similar courses completed

Military Experience (Branch)

From (Year)

To (Year)

Highest Rank Held

Location (City/State)

List Math, Science, Industrial Arts, or similar courses completed

Demographics

Gender Male Female Self-describe another way Prefer not to say

Which county do you live in?

Please mark all that apply English language learner Have a disability or impairment Are experiencing homelessness Have ever experienced incarceration or arrest Incarcerated within the past 180 days, on probation/electronic monitoring, or in alternative housing Recently exited foster care

Household Income < $15,000 $15,000 – $19,999 $20,000 – $29,999 $30,000 – $40,000 Household monthly income:

Sources of income:

Are you currently employed?

Yes No Rather not say

Have you recently lost your job or experienced a reduction in wages?

Yes No Rather not say

Are you the head of your household?

Yes No Rather not say

If not, what gender is the head of your household Male Female Self-describe another way Prefer not to say

Total number of people in your household:

Are you the parent to one or more dependent children?

Yes No Rather not say

How many dependent children live in your household?

Are you a recipient of SNAP (Supplemental Nutrition Assistance Program)?

Yes No Rather not say

Are you interested in applying for SNAP?

Yes No Rather not say

Were you on the BotsIQ team at your high school?

Yes No Rather not say

Questionnaire

Please write a few sentences for each question. One word answers will not be accepted.

Tell us about who you are, what your strengths are, what your background is. Include all credentials, degrees, and certificates earned.

Do you have any background in machining/manufacturing? If yes, please explain. If no, what is your impression of machining/manufacturing?

What interests you about machining?

Why do you think this training is the right fit for you?

Course Preference

Location	First Choice	Second Choice	Days and Times
Day Programs
M2K – Pittsburgh (South Side) 305 East Carson Street Pittsburgh, PA 15219			Monday – Friday, 9:00 am – 3:00 pm Class duration: 4-6 months
Evening Programs
M2K – Pittsburgh (South Side) 305 East Carson Street Pittsburgh, PA 15219			Monday & Wednesday, 4:00 pm – 10:00 pm Class duration: Approximately 1 year
M2K – Latrobe 4904 Route 982 Latrobe, PA 15650			Monday – Friday 4:00 pm – 9:00 pm Let us know which day(s) you are interested in. Class duration depends on hours per week

By submitting this application, you agree to the following: I certify that the facts contained in this application are true and complete to the best of my knowledge, and I understand that, if accepted into Manufacturing 2000, falsified statements on this application shall be grounds for dismissal. Furthermore, I authorize investigation of all statements contained herein and authorize the information they may have, personal or otherwise, and release New Century Careers from all liability for any damage that may result from utilization of such information. I do hereby agree and authorize that any and/or all information provided on this application may be forwarded to partners associated with New Century Careers and Manufacturing 2000 to determine possible financial aid and/or funding available to cover costs associated with my training in their program.

Manufacturing 2000 Application

Personal Information

Employment History

Education / Military Experience

Demographics

Questionnaire

Course Preference

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