ANEW/JOB SKILLS FOR TRADE AND INDUSTRY iNTERVIEWER______________________________ _______ DATE___________________________________ ASSESSMENT INTERVIEW TIME_______________________________ Residence: King County O Seattle □ NAME AA □ NA □ Hisp □ Asian □ Wh □ Other □ Age________ Birthdate_________ ADDRESS CITY STATE HOME PHONE ZIP MESSAGE# Public Assistance: AFDC/JOBS:_____________________ GAU:________ SSI: ____________________________ NAME Name & # of DSHS Case Worker:___________________ WBSCS Reading Score___________________ WBSCS Math Score______________________ Needs GED: □ yes Needs Drivers Lie: □ yes Needs Childcare: □ yes Barrier: Yes □ No □ Lacks Work Maturity: Yes □ No □ CRITERIA 1. WORK TEST Maximum points: 5 [5 = Excellent; 4 = Good; 3 = Satisfactory; 2 = Unsatisfactory; 1 =Did not participate] II. MOTIVATION Maximum points: 5 _________ Applicant arrived at the orientations and interview on time and completed budget plan and child care plan. ___ Part I 1 pt each ___ Part II ___ Interview ___ Budget (and Child Care Form, if necessary) filled out ___ Eligibility Documentation IH. KNOWLEDGE OF Maximum points: W NONTRADITIONAL WORK Applicant has experience in nontraditional work, knows people in the trades, has done research. ___ Nontraditional work experience 3 pts max _ _ Knows people in the trades 1 pt max ___ Did research 1 pt max ___ Unpaid nontraditional work exp 3 pts max ___ Completed trades class(es) 2 pts max IV. SELF KNOWLEDGE Maximum points: 8 Applicant can identify skills that will be useful ANEW andnontraditional work __ _Ability to identify future occupations _ Identifies reasons for interests in nontraditionalemployment ___ Identifies reasons for wanting to attend ANEW Total Score 1 ____________ _________ _________ _,,,.. 2 pts max 2 pts max 2 pts max 2 pts max **STAFF NOTE: PLEASE BEGIN YOUR INTERVIEW WITH A STATEMENT LIKE THIS OR READ THIS ONE IF YOU LIKE. Some of the questions we are going to ask you in this interview may be difficult or too sensitive for you to answer. Please feel that you may answer according to your comfort level. Your honesty and openness is appreciated. I. GOALS AND EXPECTATIONS 1. Why do you want to attend ANEW? (If the candidate cannot answer or answers "money" only, ask: What has motivated you in the past?) 2. What do you see yourself doing in the next two years? 3. What did you learn about yourself from completing the PAR interest survey? [Discuss PAR] How do your choices fit in with your decision to pursue nontraditional work? Can you name some trades you are interested in? __ Yes, wants to investigate employment opportunities in all trades. 4. What are the characteristics of these jobs that interest you? outdoors, making good money, stability, etc.) 5. What specific skills do you expect to gain from training at ANEW that would help you get the jobs you identified? 6. If you know anyone who does trades Work, describe what they do 2 (i.e. physical work, 7. Describe something you do well or something about yourself that would be valuable to you in doing this kind of work. 8. Please describe something in your past that you really wanted and had to work hard to get or achieve. 9. What concerns or fears do you have in returning to school? 10. What might stop you from completing this program? (What has stopped you from completing other goals?) 11. What are your concerns or fears about going into this kind of work? (Please explore the question if applicant simply states "nothing"). 12. If you are accepted into this program, part of what you are agreeing to do is find employment within 90 days of graduation. What would prevent you from obtaining nontraditional work in that time? (If the student answers "nothing", explore the reality of childcare, temporary positions, reality of time spent in job search). IL 1. WORK HISTORY What is your nontraditional paid or unpaid work history: A. What job task did you like the most? B. What job-task did you like the least? Why? 3 C. Why did you leave this job? D. Have you been fired during the last year? III. EDUCATIONAL ASSESSMENT 1. Do you have any other previous trades skills training? (Include skills training classes you might have had in high school)? A. If yes, did you receive a certificate of completion? When and where? 2. Have you completed any apprenticeship programs? 3. What kind of math classes have you completed? ____basic math ____geometry ____algebra How did you like them? 4. It is important that you know you will be expected to do both book learning and hands on learning. Do these expectations concern you? 5. Have you participated in any other JTPA training programs? If so, when and where? (i.e. CCA, CCA’s trade program at SVI, Pacific Associates, WA Works, CAMP) 6. Are you applying for any other training programs at this time? 4 7. In order to participate in ANEW, you are required to apply for a Pell Grant, which is to be used for your training expenses. Are you willing to do this? When will you apply? [Please inform applicant it is in her best interest to apply immediately] 8. Are you ineligible for Financial Aid due to previous payment defaults? 5 IV. PHYSICAL HEALTH The following list is a sample of tasks that you will be required to perform during the five month training. These and other repetitive tasks replicate trades work and are designed to help you get into good physical condition. * pick-up and carry fire hose: approximately 80 pounds * Pick-up and carry 2, 20’ #5 lengths of rebar: approximately 40 pounds * Pick-up and place a 60# bag of cement into a wheelbarrow * push wheelbarrow with 2, 60# bags of cement * pick-up and carry a 1 1/2" galvanized pipe, 21" long weighing approximately 70# * pick-up and carry 3, 8’ 2x4’s weighing approximately 25# * participate in continuous vigorous aerobic exercise for 45 minutes * digging ditches/hammering 1. Do you consider yourself physically limited in any of the following ways, which would prevent you from performing the physical requirements listed above. ____Deafness/hearing loss ____ Blindness/vision loss/color ____ Speech Impairment ____ Arthritis problems ____ Digestive, nervous disorders ____Heart problems ____ Weight ____High Blood Pressure ____Dental Problems ____Back Injury ____ Carpel Tunnel Syndrome ____Recurring Sore back ____ Shoulder Problems Knee Problems ____ Abdominal Problems ____Ankle Problems ____Diabetes _____Asthma ____Other Concerns 6 2. Are you pregnant or plan on becoming pregnant during the next 12 months? Please be aware that if you do become pregnant during the program, you will not be able to complete the program due to safety/health concerns. (I need to ask you some personal questions regarding your emotional mental health. In this program we work with the ’’whole" person. This means intellectually -- teaching trades, physically — doing physical fitness and heavy work, and emotionally - addressing personal problems or crisis that are on-going or surface while you are in the program. We find that the most common reason women leave the program is due to personal problems, not because they cannot do the work intellectually or physically. In short, we are looking for woman who are willing to work on personal barriers that affect their employability.) V. MENTAL HEALTH 1. Are you living with, or have you ever lived with a partner or family member who has been violent or abusive toward you? Describe. Have you ever sought help for this? 2. Have you ever been depressed in a way that has limited your ability to function on a daily basis (i.e. lack of sleep or sleeping all day, decreased appetite)? 3. Because we work with sophisticated equipment and power tools, it is very important to be fully alert. Are you currently taking any medications for depression?_yes,__ no. If so, how is it working? Are you concerned about your ability to stay alert during the course of the training? 4. Because of the nature of the work and the size of the class, it will be normal for you to feel irritated, frustrated or even angry with others’ learning styles or personalities. If you were having a bad day at school, what would you do? 5. Think of a situation when you felt very angry. What did you do when you reached the boiling point? 7 6. Have you taken any anger management classes? 7. How often do you use drugs/alcohol? 8. Have you ever had problems in work or school due to drugs or alcohol? 9. Have you ever had treatment for alcohol/drug use? When? Was it beneficial? 10. Have you received counseling for any other issues? If yes, what was beneficial? Would you be willing to sign a release of information for us to contact your counselor? 11. For some of our students, adapting to the role of student has been difficult because they have lived independently for many years and are not used to the student role. How do you feel about taking directions and following rules that are required here at ANEW/RTC? 12. Attendance is very important and is seen as the primary indicator for success in the trades. What kinds of things would prevent you from getting to school on time? How will you address them? VI. FAMILY AND SUPPORT ISSUES 1. One of the factors that most students note as extremely beneficial to their success in the program and in the trades is a good support system. What kind of support do you have? How will you use it when you are here? 8 2. Do you have any children? Are they living with you? Ages? How do you feel about having less time with your children (since you will be going to school full-time)? 3. What are your childcare plans? [Sign Childcare Plan] Student mothers cite the lack of back-up childcare as one of the most common reasons for time missed at school. We encourage you to take back-up childcare seriously. Who can your child (children) stay with if she/he (they) are sick? 4. Are you receiving any type of Public Assistance? If yes, what program? [AFDC, SSI, GAU, etc] A. Have you contacted your caseworker to let s/he know you are applying to ANEW? B. If you are receiving AFDC, have you been referred to the JOBS program? If yes, do you have a child care plan approved? (If not, why not?) Have you discussed the other Support Service benefits for the JOBs Program? 5. Is your living situation something you can count on for the next year? What other options do you have if your circumstances suddenly changed? 6. What form of transportation do you plan to use to get to school/work? If you are riding a bus, how will you pay for your bus pass? 7. Do you have a valid Washington Drivers license? □ YES 9 If not, why? 8. Do you have any outstanding tickets? ($) 9. One of the most difficult problems affecting women in this program is living on a low income. You are expected to support yourself during this time. What needs to be attended to in order to help you feel confident of your financial picture during the course of the training? [Review Budget Plan] VIL OTHER TRAINING RELATED ISSUES 1. Does any of the following apply to you: Yes No _ Have you been unemployed 15 out of the last 26 weeks?(Long term unemployed) _ Have you held a job for more than 3 consecutive months during the last 2 years? (Lacks significant work history) _ Have you looked for work in the past 4 weeks? (Not in labor force) _Have you worked 45 consecutive days with one employer over the past 12 months? 2.____ Have you ever thought you had a learning disability? 3.____ Have you ever been arrested or convicted? If the applicant is an adult or juvenile who is or has been subject to any stage of the criminal justice process for whom services under JTPA may be beneficial or who requires assistance in overcoming artificial barriers to employment resulting from a record of arrest or conviction. If the applicant is an adult or youth who requires assistance in overcoming barriers to employment resulting from a record of arrest or conviction (excluding misdemeanors). 4. Do you have any pending legal problems that may cause you to miss time at school? 5. ____Yes, this applicant is a displaced homemaker. Do you consider yourself a displaced homemaker? ("Yes" if the applicant has been providing unpaid services to family members in the home and is unemployed or underemployed and is experiencing difficulty in obtaining or upgrading employment and who has been dependent either: a) On public assistance and whose youngest child is within 2 years of losing eligibility under Part A of Title IV of the Social Security Act (41 U.S.C. 601 et seq.); or b) On the income of another family member but is no longer supported by that income. Do you have any questions? 10 PLAN OF ACTION/PRIOR TO ACCEPTANCE Drivers License Due_______________ Birth Certificate/Voter’s Registration, etc. Due Medical Note Due Budget Form Due Social Security Number Financial Eligibility Documentation Basic Skills: Prior to Training □ Due Due Concurrently □ Child Care Arrangements: □ AFDC/JOBS □ JTPA/KC □ Needs to complete back-up plan □ In-home daycare Housing □ Own Resources Due Counseling Release Due I CERTIFY THAT I AGREE WITH THE INTERVIEW ASSESSMENT WHICH HAS BEEN COMPLETED, THAT I HAVE RECEIVED AN ORIENTATION TO THE PROGRAM AND HAVE BEEN PROVIDED WITH A COPY OF THE COMPLAINT AND GRIEVANCE PROCEDURE. Applicant Date Interviewer 11 Date FOR STAFF USE ONLY PROGRAM ENTRY CRITERIA A. Minimum COMMENTS - □ YES □ NO WBSCS appraisal score of 200 or above in reading and math. □ YES □ NO If scoring below 230/225 enrollment into the Learning Center Basic Skills Remediation. □ YES □ NO Satisfactory or better on the physical test □ YES □ NO A score of 20 or better on the interview. □ YES □ NO All required documentation in prior to training. □ YES □ NO Income Eligible via application. □ YES □ NO If GED needed, enrollment into Learning Center. B. Maximum □ YES □ NO Completed an apprenticeship program. □ YES □ NO Completed a similar nontraditional vocational training program with proven marketable skills. □ YES □ NO Completed a two year, four year, or advanced degree program. WORK MATURITY CHECKLIST Yes No 1. “ Has the participant worked full time/part time for at least 45 consecutive work days with one employer over the last 12 months? (see pg. 10) Did the participant arrive on time for the scheduled appointment? 2. 3. « 4. ______ Was the participant neat and clean in appearance? Has the participant been fired during the last year? (see pg. 4) A "no" in either 1, 2, or 3 or a "yes" for 4 means this individual does not have work maturity according to the PIC. FINANCIAL ASSISTANCE CHECKLIST □ Yes □ No Will apply for Pell Grant □ Yes □ No Eligible for Needs Base Payment □ Yes □ No Needs student accident insurance 12