Application

APPLY TO PROGRAM

What are the requirements to apply for the program?

Class Times:
Monday, Tuesday, Thursday 5:00 p.m. to 8:10 p.m.
Phone: 936-632-2035
Leave a message if your call is not answered

Please download application or complete online.

Participant Application

* Indicates required field

Name *

First

Last

Email *

Address *

City *

Phone *

State *

Date of Birth *

ZIP CODE *

Marital Status *

If married, spouse's name *

HIGHEST LEVEL OF EDUCATION *

DO YOU ATTEND CHURCH? *

Yes No

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 of Employment) *

WHAT IS YOUR CURRENT SOURCE OF INCOME? *

OF ALL YOUR JOBS, WHICH DID YOU LIKE BEST AND WHY? *

ARE THERE ANY CIRCUMSTANCES IN YOUR LIFE THAT MAY CREATE PROBLEMS FOR YOU WHILE PARTICIPATING IN THE PROGRAM? *

DO YOU HAVE SOMEONE YOU CAN CONFIDE IN? *

YES NO

HOW DID YOU HEAR ABOUT THE CHRISTIAN MEN'S JOB CORP (CMJC)? *

HOW DO YOU THINK THE CMJC CAN HELP YOU? *

GIVE THREE REFERENCES WE MAY CONTACT (NAME, RELATIONSHIP, PHONE NUMBER) *

Submit

Christian Men's Job Corps
at
The Men's Fieldhouse
1813 E. Denman Ave Lufkin, Texas 75901
(936) 632-2035
info@themensfieldhouse.org