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Escambia CountyFlorida
U.S. Citizen
Do you have a valid State Driver's License or State ID?

PRIMARY EMERGENCY CONTACT INFORMATION

SECONDARY EMERGENCY CONTACT INFORMATION

EDUCATION

If you were not enrolled in a training answer N/A.

Do you have a High School diploma or GED?
Have you completed any college?
Have you earned any industry certifications?

CAREER/TRAINING INTERESTS

Please select all that apply.

ADDITIONAL INFORMATION

Please select all that apply.
Do you have reliable transportation?
Do you need assistance with transportation?

CRIMINAL HISTORY

Do you have a prior criminal record?
I voluntarily consent to a criminal history background check, and to a thorough investigation of my present and past employment and other activities, for the purpose of verifying my qualifications.
*NOTE: A criminal record DOES NOT automatically disqualify you from participation in the Block-by-Block program.

BLOCK BY BLOCK ELIGIBILITY VERIFICATION

The next questions will ask which documents you will be bringing to verify eligibility.

You will need one of the following to verify your Social Security Number
You will need one of the following to verify your Birthdate/Age
You will need one of the following to verify your Citizenship/Alien Status
You will need one of the following to verify your Mailing Address.
You will need one of the following to verify your Family Income.
Are you a military veteran?
Do you have a copy of your DD-214, Page 4?
Are you a Public Assistance recipient?
Do you have a copy of your TANF Statement?

AGREEMENTS

I am currently drug free and will remain drug free throughout my participation in this program. I pledge that I will take reasonable action to create and maintain a workplace free from substance abuse.
I will attend work, school and meetings as scheduled unless there is a legitimate emergency. I understand that habitual tardiness and absences will result in disqualification from this program.
How did you find out about this program?
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The mission of Escambia County government is to provide efficient, responsive services that enhance our quality of life, meet common needs and promote a safe and healthy community.

Under Florida law, IP addresses and both the content of emails and email addresses are public records. If you do not want your IP address and the content of your email or your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in person.

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