EMPOWER GEORGIA

EMPOWER GEORGIA APPLICATION

Please fill out the entire form. For questions or issues, please email at mdjordan7@bellsouth.net

Pre-requisites for applying:

This is a training for justice-involved individuals
No open cases are allowed
No convictions related to sex offenses or medicare/medicaid fraud.
A GED/High School Diploma is required for most positions; however, if you do not have a GED/HSD, other positions may be available.

Title

First Name

Last Name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Telephone #

What's the date of your last arrest?

What's the date of your last conviction?

Do you have any pending charges or open cases? All cases must be disposed prior to applying for this program.

YES

Have you ever seen your criminal record?

YES

Were you arrested and/or convicted in the state of Georgia?

YES

Are you currently being supervised on State or Federal probation/parole?

YES

How long of a sentence did you serve in jail or prison?

Have you obtained or requested/applied for an expungement for any cases for which you were arrested?

YES

Have you applied for or obtained a Certificate of Relief/Rehabilitation or Certificate of Good Conduct to remove barriers to employment for any cases for which you were convicted?

YES

If you served time in prison or jail, did you work while incarcerated?

YES

Have you completed any programs, mandates, or courses that can attest to your rehabilitation, lifestyle change, and prosocial living (including, but not limited to drug court, probation/parole, addiction treatment, anger management, parenting, or others)?

YES

In a short paragraph, explain your involvement with the justice system.

Please describe any achievements or areas of accomplishments while incarcerated (if applicable)

What is the highest grade completed K-12?

Do you have a GED or HS Diploma ?

GED

HS Diploma

Did you complete any college or vocational training programs ?

YES

Do you have military service experience?

YES

What are your short term and long term goals.

What would you describe as the greatest accomplishment of your life?

Please describe any particular skills you have that will assist us in identifying employment opportunities. For example, welder, carpenter, chef, etc.

Write a summary below by answering the following questions:

Tell us about your background and what life was like for you growing up.
What are some of the biggest lessons have you learned from your experiences?
Where do you see yourself in the next few years and what steps are you taking to get there?
How has your experience with in the justice system influenced your view on life and your goals?

Personal Summary

EMAIL YOUR RESUME.

In order to move to the next phase of interviews, please send your resume to mdjordan7@bellsouth.net. Your application will not be considered if we don't recieve your resume.

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