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Senior Community Service Employment Program

Senior Community Service Employment Program

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Courtyard by Marriott

Waterbury, CT United States

October 2015

Diverse Ability Career Fair

October 29, 2015 @ 11:00 am - 3:30 pm

Courtyard by Marriott Waterbury, CT United States + Google Map

The CT Department of Labor and Department of Rehabilitation Services Present: Diverse Ability Career Fair Thursday, October 29, 2015 11 am - 3:30 pm Courtyard by Marriott, Waterbury, CT

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

© 2024 Associates for Training & Development | We are an equal opportunity employer / program • Know your rights: workplace discrimination is illegal • Auxiliary aides and services are available upon request to individuals with disabilities

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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
Email
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*
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*
Secondary Phone
Email
Program Eligibility
Are you unemployed?*
- Yes
If yes, for how long?*
Age Range*
- 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 $18,825.00

2 $25,550.00

3 $32,725.00

4 $39,000.00

5 $45,725.00

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)
- Stock Clerk
- Childcare
- Janitorial/Environmental Services
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?*
- None
- Basic
- Intermediate
- Proficient
How would you describe your writing communication skills?*
- Poor
- Good
- Excellent
Please identify other agencies you are currently receiving services from*
- Workforce Investment and Opportunity Act (WIOA)
- Department of Labor / American Job Center
- Vocational Rehabilitation
- Adult Education
- Other
- None
Other agency*
If other, please specify
Employment History*
Employer's Name Job Title / Description of Work Start Date / End Date City, State
How did you hear about us?*
Please choose one
- Department of Labor referral
- Referral from another agency
- Current / past participant
- Newsletter
- TV or radio broadcast
- Printed advertisement
- Other
Other*
If other, please specify
Other Agency*
If other, please specify
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“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

The Vermont Returnship Program Application: 1 of

“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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Size of Family	Maximum Allowed Family Income (what is counted)
1	$18,825.00
2	$25,550.00
3	$32,725.00
4	$39,000.00
5	$45,725.00

Employer's Name	Job Title / Description of Work	Start Date / End Date	City, State

Courtyard by Marriott

October 2015

Diverse Ability Career Fair

Are you eligible for SCSEP?

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

Let's get started

Program Eligibility

Income Eligibility

Sources of Income

Employment and Training

Additional Info

The Vermont Returnship Program Application: 1 of