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Senior Community Service Employment Program
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CT Older Worker Virtual Training Program Application

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Senior Community Service Employment Program
The Vermont Returnship Program
Learn IT 2 Work
CT Older Worker Virtual Training Program Application

Add Job Listing

Submit a job to the A4TD Job Board

Job Title*
Please enter a job title for this listing
Job Type*
- Full Time
- Part Time
- Contract
- Returnship
Job Category*
- Hospitality and Tourism
- Sales
- Healthcare
- Clerical
- Warehouse / Stock
- Food
- Delivery
- Transportation
- Finance
- Security
- Education / Training
- Retail
- Customer Service
- Other
- Construction
- Office Admin
- Communications
- Non-profit
- Audio/Video
- Natural Resources
- Arts
- Maintenance
- Architecture
- Management
- Agriculture
- Janitorial / custodial
- Animal care
- Information Technology
- Receptionist
- Human Services
- manufactoring
- Human resources
- Merchandiser
Company Name*
Enter the company name
Company Website
Enter the employer website
Job Description*
Please enter a job description
Job City*
Job State*
Application URL
Document
Upload a document in PDF format.
Accepted file types: pdf.
Email
This field is for validation purposes and should be left unchanged.

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1-800-439-3307 | 1-802-524-3200 | info@a4td.org

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© 2022 Associates for Training & Development | We are an equal opportunity employer / program • Auxiliary aides and services are available upon request to individuals with disabilities

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Pharmacy Technician in Training Application: 1 of

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CT Older Worker Virtual Training Program Application: 1 of

We also offer a printable version of the application. Feel free to download, print, complete and submit following the directions on the application.

Download Printable Version

Date*
Date Format: MM slash DD slash YYYY
First Name*
Last Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Date of birth*
Date Format: MM slash DD slash YYYY
Age*
Current employment status*
- Employed
- Unemployed
Last date of employment*
Date Format: MM slash DD slash YYYY
Are you currently looking for work?*
- Yes
- No
Number In Family?*
Current household income*
Do you have access to transportation (public or private) to access in-person training?*
Is there any reason why you can't access in-person training? If yes, what?
Do you have access to a computer that could be used for training and job search?*
Do you currently have internet access at home?*
How would you describe your computer skills?*
- None (I cannot use the machine at all)
- Basic (I can turn on the computer, and use it for very basic functions like typing in a Word document)
- Intermediate (I use email, I can open attachments, I can go to a website, etc.)
- Advanced (I am very comfortable with the computer and can do most or all of what I need to do)
Level of education*
What is your occupational goal?*
- Customer Service
- Food Preparation / Service
- Office Administration
- Retail Sales
- Stock Clerk
- Transportation
- Unknown / undecided
- Other
Are you currently enrolled in any other training program?*

“Having access to a computer changes everything for me. It means I can get training and connect with people, plus I can apply for jobs at home. It’s critical and I’m so grateful to have the help.”

Don Program Participant in CT

Are you eligible for SCSEP?

We also offer a printable version of the application. Feel free to print and complete, then fax it to us at 802-524-9933 or scan and email to apply@a4td.org.

Download Printable Version

Are you unemployed?*
- Yes
- No
Age Range*
- Below 55
- 55-59
- 60-64
- 65-69
- 70-74
- 75 & Over
Phone
This field is for validation purposes and should be left unchanged.

Senior Community Service Employment Program (SCSEP) Application: 1 of

Let's get started

We also offer a printable version of the application. Feel free to print and complete, then fax it to us at 802-524-9933 or scan and email to apply@a4td.org.

Download Printable Version
Today's Date*
Date Format: MM slash DD slash YYYY
Name*
Last First
Address*
Street Address Address Line 2 City State ZIP Code
What is your county of residence?*
Primary Phone*
Cell Phone
Email
Program Eligibility
Are you unemployed?*
- Yes
- No
If yes, for how long?*
Age Range*
- Below 55
- 55-59
- 60-64
- 65-69
- 70-74
- 75 & Over
Did you or your spouse serve as an active member in the U.S. military, naval, or air service and was discharged or released from such service under conditions other than dishonorable?*
- Yes
- No
Have you participated in the SCSEP Program in the past?*
- Yes
- No
Income Eligibility

Size of Family Maximum Allowed Family Income (what is counted)

1 $16,988.00

2 $22,888.00

3 $28,788.00

4 $34,688.00

5 $40,588.00

Sources of Income
What is counted as income*
- Pensions
- Interest for IRA and other retirement accounts
- Wages from an employer
- 75% of Social Security Retirement Benefits
- Alimony
- Rents, estates and trusts
- None of the above
What is not counted as income:*
- Unemployment Compensation
- Social Security Disability
- SSI payments through Social Security
- State assistance i.e. Food Stamps / SAGA medical / Cash
- Subsidized housing
- None of the above
Total annual counted income*
Round to the nearest dollar; do not use punctuation or dollar sign.
Total number of people in your family*
Employment and Training
Desired Occupational Goal*
- Food Preparation & Service
- Customer Service
- Retail, Sales, & Related
- Office & Administrative Support
- Personal Care & Service
- Healthcare Support (e.g. CNA, Patient Tech)
Amount of Time You Will Need for Occupational Skills Training*
- Over 1 month up to and including 3 months
- Over 3 months up to and including 6 months
- Over 6 months up to and including 1 year
- Over 1 year up to and including 2 Years
- Over 2 Years up to and including 4 years
- Over 4 years
Additional Info
Are you looking for Full-Time or Part-Time work?*
- Full-Time
- Part-Time
What is your highest level of education?*
If college, degree studied?
What is your primary source of transportation?*
So we can best satisfy your needs, please tell us if you are homeless or at risk of homeless*
- Yes
- No
How would you describe your math skills?*
- Poor
- Good
- Excellent
What is your computer skill level?*
- Basic
- Intermediate
- Proficient
How would you describe your writing skills?*
- Poor
- Good
- Excellent
Please identify other agencies you are currently receiving services from*
- Workforce Investment Act (WIA)
- Department of Labor
- Vocational Rehabilitation
- Adult Education
- Other
- None
Employment History*
Employer's Name Job Title / Description of Work Start Date / End Date City, State
How did you hear about us?*
- Department of Labor referral
- Referral from another agency
- Current / past participant
- Newsletter
- TV or radio broadcast
- Printed advertisement
- Other

“The SCSEP was a turning point in my career and my life. I grew in many ways. I recommend trying the program to anyone who wants training and help finding a job that they actually like.”

Don SCSEP Participant

Learn IT 2 Work Application: 1 of

Let's get started

We also offer a printable version of the application. Feel free to print and complete, then fax it to us at 800-901-1531 or scan and email to apply@a4td.org.
Today's Date*
Date Format: MM slash DD slash YYYY
Name*
Last First
Residence*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Primary Phone*
Cell Phone
Email*
Program Eligibility
Are you employed?*
- Employed
- Unemployed
Age*
- 18-25
- 26-35
- 36-45
- 46-55
- 56-65
- 66-75
- 75+
Are you currently enrolled in the SCSEP?*
- Yes
- No
Have you participated in any program run by A4TD in the past?*
- Yes
- No
If yes, what program?
- SCSEP (Senior Community Service Employment Program)
- AWI (Aging Worker Initiative)
- Learn IT To Work
- Vermont Returnship Program
- Other
Please describe your computer skills*
- No computer skills
- Very basic skills
- Basic - intermediate skills
- Intermediate skills
- Intermediate - expert skills
- Expert skills
- I'm not sure!
What is your highest level of education?*
If you have a college degree, what degree did you obtain?
How would you describe your reading skills?*
- Poor
- Good
- Excellent
How would you describe your writing skills?*
- Poor
- Good
- Excellent
Please identify other agencies from which you are currently receiving services.*
- Workforce Innovation and Opportunity Act (WIOA)
- Department of Labor / American Job Center
- Vocational Rehabilitation
- Adult Education
- Apprenticeship or Internship Program (with any provider)
- Other
- None
How did you hear about us?*
- Department of Labor / American Job Center
- Vocational Rehabilitation
- Current / past participant
- Newsletter
- Print materials at another agency
- TV or radio broadcast
- Printed advertisement
- Other

“I used to have such anxiety about using a computer, now I navigate like a whiz. I smile every time I turn it on.”

Don SCSEP Participant

The Vermont Returnship Program Application: 1 of

Let's get started

We also offer a printable version of the application. Feel free to print and complete, then fax it to us at 802-524-9933 or scan and email to apply@a4td.org.

Download Printable Version
Today's Date*
Date Format: MM slash DD slash YYYY
Name*
Last First
Age*
This has no impact on program eligibility. We collect it for statistical purposes only!
- 18-25
- 26-35
- 36-45
- 46-55
- 56-65
- 66-75
- 75+
What is your primary source of transportation?*
Email*
Primary Phone*
Cell Phone
Residence*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Career Status
Are you employed?*
- Employed
- Unemployed
Do any of these describe you?*
Check all that apply. This has no impact on your eligibility. We just want to get to know you, and this info helps us serve you better.
- I am a parent returning to work after having children
- I am employed, but underemployed
- I am a caregiver who was out of the workforce while caring for a family member
- I am an active duty member of the armed forces
- I am a retired or returning military member
- I want to reinvent to a new career
- I retired from my previous career and now I want to try something new
- I cannot continue to work in my previous occupation for physical reasons
- I met a mandatory retirement age in my last job, now I want to do something else
- I come from the corrections system and want to reenter the labor force
- I was not working for a time, on account of addiction or substance abuse
Occupational Goals
If you could choose, what type of work would be your preference?
Check all that apply
- Employment - Full-time
- Employment - Part-time
- Employment - Seasonal
- Volunteer work
- No Preference / Unsure
Desired Occupational Goal*
Check any and all that interest you!
- Sales / Retail and Related
- Food Preparation & Service
- Office and Administrative Support
- Personal Care and Service
- Customer Service
- Human Services
- Transportation and Material Moving
- Education, Training and Library
- Construction and Extraction
- Facilities / Maintenance
- Installation and Repair
- Production / Manufacturing
- Management
- Business and Financial Operations
- Community and Social Service
- Healthcare
- Arts / Design / Entertainment
- IT / Tech Support
- Protective Service
- Science and Mathematics
- Life and Social Science
- Farming, Fishing, and Forestry
- Green Jobs
- Architecture and Engineering
- Hospitality
- Pharmaceutical
- Legal
- Childcare
- Non-Profit
- I don't know!
- Other
Other occupational goal
If other, please specify
Qualifications, Skills, and Experience
What is your highest level of education?
Degree
If you have a college degree, what degree did you obtain and in which year did you receive your degree?
Certifications, credentials, and licenses
Please list all of your notable certifications, credentials, and licenses
Please list any information which might inhibit your employment options
Your answer to this question has no impact on your eligibility for this program, we simply wish to gather pertinent information to most successfully match you with an employer
Is there any other personal information you would like to share which might be beneficial for an employer to know?
Your answer to this question has no impact on your eligibility for this program, we simply wish to gather pertinent information to most successfully match you with an employer.
How would you describe your math skills?*
- Poor
- Good
- Excellent
How would you describe your reading skills?*
- Poor
- Good
- Excellent
How would you describe your writing skills?*
- Poor
- Good
- Excellent
How would you describe your computer skills?*
- Basic
- Intermediate
- Excellent
Employment History

Please identify your three most recent places of employment
Employer #1
Company Name
Job Title
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Worked
Employer #2
Company Name
Job Title
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Worked
Employer #3
Company Name
Job Title
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Worked
Additional Information
Please identify other agencies from which you are currently receiving services.*
- Workforce Innovation and Opportunity Act (WIOA)
- Department of Labor / American Job Center
- Vocational Rehabilitation
- Adult Education
- Apprenticeship or Internship Program (with any provider)
- Other
- None
Other agency
If other, please specify
Have you participated in any program run by A4TD (formerly Vermont Associates for Training) in the past?*
- Yes
- No
If yes, which program?
- SCSEP (Senior Community Service Employment Program)
- AWI (Aging Worker Initiative)
- Learn IT 2 Work
- Other
Other program
If other, please specify
How did you hear about us?*
- Newsletter
- Printed advertisement
- Print materials at another agency
- TV or radio broadcast
- Department of Labor / American Job Center
- Vocational Rehabilitation
- Current / past participant
- Other
Other referral
If other, please specify

“I found an opportunity to try something new. It helped me see I have a lot of skills and a lot to offer! I'm optimistic that I have a positive path ahead of me”

Renee Returnship Participant

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