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What are the requirements to apply for the program?

Name:

Phone:

Email:

Address:

City:

State:

Zip:

Date of Birth:

Marital Status:

If married, Spouse:

Highest Level of Education

Do you attend Church?

If YES, where?

Who lives in the same house as you? (PLEASE provide the following: Name, Age, Relationship)

Beginning with the MOST Recent, Where have you worked? (Employer, Title, Last Date)

What is your current Source of income?

Of all your jobs, which one did you like best and why?

Do you have someone you can confide in?

How did you hear about the Christian Men's Job Corp?

How do you think the CMJC can help you?

Give Three References we can contact: