PPN FORM
Do you hold a Bachelors Degree or higher?
*
Yes
No
Were you previously earning a salary of $47,000 per year or higher?
*
Yes
No
Select a workshop you can attend
*
:
Please select
Cannot Attend
Contact Information
First Name
*
:
Last Name
*
:
Telephone Number
*
:
Email
*
:
Alternate Telephone Number
*
:
SSN (Last 4)
*
:
Are you able to attend all five modules of the PPN Virtual Series? (Attendance for all modules is required to complete registration. If you are unable to attend all modules, please speak with the team during the workshop.)
*
Yes
No
Do you have reliable transportation?
*
Yes
No
Will you be able to attend and be dressed for interviews each day?
*
Yes
No
Are you currently working?
*
Yes
No
Are you registered in Employ Florida(EF)?
*
Yes
No
Employ Florida ID
Is your most updated resume uploaded to EF?
Yes
No
Last/Current Occupation
*
:
Last/Current Job Title
*
:
Last Salary?
*
Please select
$0 to $46K
$47K to $69K
$70K+
Working
*
Select Answer...
Part Time
Full Time
Seasonal
Education Status
*
Please select
Less than High School
GED
High School Diploma
Some College
Associates
Bachelors
Masters
Doctorate
Highest Annual Income?
*
Please select
$30,000 - $46,999
$47,000 - $100,000
Over $100,000
Number of years in a management or higher position?
*
:
Please select
None
1-2
3-5
6-10
11-20
Over 20
Comments
*
:
Military Service
Are you currently in the military, a veteran, or spouse of a veteran?
*
Yes
No
Are you the spouse/dependent of someone in
Active Duty
of the Military, National Guard, or Reserves?
Yes
No
Are you a current member of the Florida National Guard?
Yes
No
Are you within 24 months of retirement or 12 months of discharge from the military (Transitioning Service Member)?
Yes
No
Have you served on active duty in the Armed Forces and were discharged or released from such service under conditions other than dishonorable?
Yes
No
Are you the spouse of a veteran who has a total service connected disability, is missing in action, captured in the line of duty by hostile forces, a prisoner of war, or who died from a service connected disability?
Yes
No
Are you now or have you served in a National Guard or Reserve unit that was called to or is on active duty due to armed conflict and/or crisis involving National Security (Title 10 Activation)?
Yes
No
