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WDBSCW Full Programs Application Part 1

If you need assistance in completing this application, staff is available to assist you. Employment and training programs are designed to help adults, dislocated workers and youth pursue high-growth, high-wage career pathways. Programs and services are individualized and based upon eligibility and assessed need. Application does not guarantee participation. Attach additional pages if necessary.

Personal Info

County of Residence
Race/Ethnicity
Are you authorized to work in the U.S.?

The Workforce Development Board of South Central Wisconsin and WorkSmart Network are equal opportunity employers and program service providers. If you need this information or printed material in an alternative format or in a different language (any of these free of charge), please contact us at 608-249-9001. Deaf, hard of hearing or speech impaired callers may contact us through Wisconsin Relay Services at 7-1-1. Proud partners of the American Job Center network. This workforce product was funded by a grant awarded by the U.S. Department of Labor’s Employment and Training Administration. The product was created by the recipient and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties or assurances of any kind, expressed or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. This product is copyrighted by the institution that created it. v20231229v

WDBSCW Full Programs Application Part 2

If you need assistance in completing this application, staff is available to assist you. Employment and training programs are designed to help adults, dislocated workers and youth pursue high-growth, high-wage career pathways. Programs and services are individualized and based upon eligibility and assessed need. Application does not guarantee participation. Attach additional pages if necessary.

County of Residence

Dislocated Worker

Were you ...
Per

The Workforce Development Board of South Central Wisconsin and WorkSmart Network are equal opportunity employers and program service providers. If you need this information or printed material in an alternative format or in a different language (any of these free of charge), please contact us at 608-249-9001. Deaf, hard of hearing or speech impaired callers may contact us through Wisconsin Relay Services at 7-1-1. Proud partners of the American Job Center network. This workforce product was funded by a grant awarded by the U.S. Department of Labor’s Employment and Training Administration. The product was created by the recipient and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties or assurances of any kind, expressed or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. This product is copyrighted by the institution that created it. v20231229v

WDBSCW Full Programs Application Part 3

If you need assistance in completing this application, staff is available to assist you. Employment and training programs are designed to help adults, dislocated workers and youth pursue high-growth, high-wage career pathways. Programs and services are individualized and based upon eligibility and assessed need. Application does not guarantee participation. Attach additional pages if necessary.

County of Residence

Authorization to Release Information

Please review this Authorization to Release Information form carefully. If you have any questions, contact your Career Planner.

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The exchange of information, in conjunction with your participation in WDBSCW-administered programs, allows the Workforce Development Board of South Central Wisconsin (WDBSCW) and its service providers to work together with other agencies, when necessary, to determine program eligibility, effectively coordinate services and referrals, and support the achievement of training and employment goals. Staff are required to keep and use information in a confidential and responsible manner in accordance with federal and state regulations. Examples in which we may seek to obtain and/or share necessary and pertinent personal information include:

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  • Eligibility and service provision

    • Determining eligibility and required criteria for WDBSCW-administered programs, services and activities

    • Confirming or securing related services and assistance through other programs and partners of the American Job Center network

  • Education

    • Accessing educational records (current and past) including but not limited to educational assessments, transcripts, financial statements, outcome information, diploma/certificate/credential(s) obtained, and/or attendance records

  • Employment

    • Speaking with employer(s) on your behalf regarding job opportunities or providing them with your resume

    • Verifying past or current employment including but not limited to wage information, fringe benefits, date of hire, hours worked per week and position title

Acknowledgement

The Workforce Development Board of South Central Wisconsin and WorkSmart Network are equal opportunity employers and program service providers. If you need this information or printed material in an alternative format or in a different language (any of these free of charge), please contact us at 608-249-9001. Deaf, hard of hearing or speech impaired callers may contact us through Wisconsin Relay Services at 7-1-1. Proud partners of the American Job Center network. This workforce product was funded by a grant awarded by the U.S. Department of Labor’s Employment and Training Administration. The product was created by the recipient and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties or assurances of any kind, expressed or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. This product is copyrighted by the institution that created it. v20231229v

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