Power2Workers Placement Intake Form Date MM DD YYYY Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * How did you hear about us? * Are you currently available to work? Yes No * Do you have reliable transportation? Yes No * Do you have two forms of ID: (SS card & official picture ID? Yes No Are you bilingual? Yes No Do you have stable housing and food? Yes No Do you have childcare? Yes No N/A Is 6:00 am a comfortable time to begin work? Yes No Are you confident that you will be able to perform well on the job? Yes No Do you prefer to work on a team? Why? Which trade would you prefer to be placed in? Do you hold any certifications? Tell us about your competed training &/or Relevant work experience. What is your salary requirement? $ Do you have any court ordered mandates that may affect your employment? Yes No Explain: Are you on probation? Yes No If so, what is the contact information for your parole officer?: SMS Opt-In * By opting in you agree to our Terms and Conditions. Opt-In Opt-Out Thank you for your application!
