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YCC HVAC/R Application
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YCC HVAC/R Application
HVAC/R Application
YCC HVAC/R Application
First Name
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Last Name
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Phone Number
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Email Address
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Home Address
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What type of housing situation best applies to you?
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Public Housing
Own a Home
Renting
Shelter
Homeless
Race / Ethnicity
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Black / African American
Hispanic / Latino
White / Caucasian
Native American
Other
Sex
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Your Age
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17
18
19
20
21
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23
24
Birth Month
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01-Jan
02-Feb
03-Mar
04-Apr
05-May
06-Jun
07-Jul
08-Aug
09-Sep
10-Oct
11-Nov
12-Dec
Birth Day
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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23
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25
26
27
28
29
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Birth Year
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2002
2001
2000
1999
1998
1997
1996
1995
Do you have a valid social security number (SSN)
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Do you have a valid form of official photo identification?
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Yes
No
This includes a Driver's license or a state ID.
Do you currently receive any government assistance? If yes, what kind? (SNAP, housing, etc)
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Have you completed high school?
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Yes
No
No, but some GED
No, but earned GED
Are you on probation?
*
Yes
No
Are you on parole?
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Yes
No
Have you held a job before?
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Yes, I am working now.
Yes, but I am not working now.
No.
If you are working now, please describe your current job.
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Do you have any health conditions that we should know about? (Ex. diabetes, asthma, allergies, pregnancy)
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