The IT Training Institute | A Unique Learning Environment

New Jersey Career Center - Quality Training, Education and Job Placement Services for IT, Office Administration, Medical Billing and Coding, Medical Office Administration and Professional Development

Applicant Information

Full Name
Address		Apartment/Unit#
City		State
Phone		Zip Code
Email Address		Date of Birth
Social Security No		Referral Source
Name of Counselor & Contact info(if from One Stop, etc.)

Are you a citizen of the United States?	Yes	No	Are you authorized to work in the U.S.?	Yes	No
Have you ever had any other computer training?	Yes	No
Do you have any computer certifications?	Yes	No

(OPTIONAL – NOT REQUIRED) THE HIGHLIGHTED INFORMATION IS FOR STATE AND FEDERAL REPORTING USE ONLY
Gender		Single Parent?
Race or Ethnicity		Displaced Homemaker?
Disabilty Y / N		If yes explain:

Education

High School:		Address:
From:		To
Did you graduate?	Yes No	If no GED?
College:		Address
From		To
Did you graduate?	Yes No	Degree, If no how many credits:
Other		Address
From		To
Did you graduate?	Yes No	Degree:
Are you currently attending any educational institutions?		If yes, where?
What course of study?

Current or Most Recent Employment

Company:		Phone
Address		Supervisor or HR Manager:
Job Title:

Military Service

Branch:		Rank at Discharge:
From		To
Vocation while serving:

Referrals

Please list anyone who you feel would be interested in finding out about our school.
Full Name		Relationship:
Company		Phone
Address
Full Name		Relationship:
Company		Phone
Address
Full Name		Relationship:
Company		Phone
Address

Why are you interested attending IT Training Institute?

What are your career goals:

a career in the Computer Market or
upgrading my existing computer skills
Other

What (if any) experience, personal or on the job do you have with computers? (Please include both Hardware and Software experience were applicable)

What programs (if any) have you used?

How have you used the Internet?

What job experience do you have?

What would you like to be able to do with a PC?

What kind of work would you like to do with computer training? (please circle)
Field Work, Administration, Programming, Training/Teaching, Sales, Personal Use

What kind of schedule do you have (work, school, home life)?

If accepted, when would you like to begin your program?

If accepted, what schedule would you most likely prefer? (our scheduling is flexible for all our students but we ask students to select the schedule they would most likely be attending.)

Mornings

Evenings

Nights

Weekends

My schedule will vary due to other commitments


	Press Release 2/22/2015 - Advisory Board Committee formation

	Congratulations to Yulisbet Zayas for passing CMAA

	Notes 1/15/2015 - Guest Speaker - Williemae Latimore

	Press Release 1/15/2015 - Guest Speaker - Williemae Latimore

	Congratulations to Diana Kathary for passing CMAA

	- Press Release 4/13/2013


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