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NORTHCENTRAL ARKANSAS

Workforce Development Area

Tel: 870-793-5233

4441 Harrison Street

Batesville, AR 72501

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Apply

Number of Family Members in Household

Social Security Number Optional

Race (check all that apply) * Required

Ethnic Hispanic/Latino

African American

American Indian or Alaska Native

Asian or Asian American

Hawaiian or other Pacific Islander

White or Caucasian

Not self-identified

Prefer Not to Answer

Are You employed? *

Yes

No

Are you registered with Arkansas Job link? *

Yes

No

Not sure

Are you a veteran? *

Yes

No

are you the spouse of a veteran? *

Yes

No

Are you registered with selective service? *

Yes

No

No, because I was born Female

Not sure

Check All That Apply

I am receiving SNAP

I am receiving TEA

I am receiving SSI

I am receiving SSDI

I was laid off

I am a single parent (custodial or non-custodial)

I am a single pregnant woman

I am 24 or younger and am pregnant or parenting

I have been subject to the criminal justice process for committing a status offense or delinquent act

I have been unemployed for 27 or more consecutive weeks

I am currently homeless

I have a physical, mental, or learning disability

English is *not* my primary language

I have been in or am currently in the foster care system

If you are currently attending College or other training please complete the following:

What funding are you receiving for the training? (Check all that apply)

Pell

Scholarships

Grants

Career Pathways

Arkansas Rehabilitation Services

Trade Agreement Act (TAA)

Student Loans

Other Funding

None

By completing this initial application, you authorize WIOA to share the information with our partner agencies to see that you get the best help needed.

By checking this box I am stating that this information is true to the best of my knowledge

You have submitted!!

Searcy Workforce Center
501 West Arch Street
Searcy, AR 72143
Phone: (501) 268-6650
Days of Operation: Mon-Fri
8:00am-4:30pm
Contact: jamie@wrpdd.org

WRPDD/Arkansas Workforce Center is an “equal opportunity employer/program.” Auxiliary aids and services are available upon request to Individuals with disabilities. Arkansas Relay Service: 1-800-285-1121 (Voice) 1-800-285-1131 (TDD) Or TDD 711.

© 2017 Northcentral Arkansas WIOA Board

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