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Grundy Workforce Services

Young Professionals Network
1715 N. Division Street
Morris, IL 60450
Phone: (815) 942-0566
Fax: (815) 942-1547

Angellica Ahng
Workforce Skills Manager
Grundy Workforce Services
Phone: (815) 280-6823
Email: aahng@jjc.edu

Hours:
Monday-Friday: 8am - 4:30pm
Thursday: 8:00am - 7:30pm

Go to IllinoisWorkNet.com

Home » Continuing Education » Grundy Workforce Services » Young Professionals Network » Membership Application

Membership Application

First Name

Last Name

Address 1

Address 2 (Optional)

City

State

Zip Code

County

Birth Date (MM/DD/YYYY)

Home Phone Number

Other Phone (Optional)

Ethnicity

Hispanic

Yes
No

High School Status

If attending, what is the highest level completed?

Are you a United States Citizen?

Yes
No

If not, are you permitted to work in the U.S.?

Yes
No

Are you attending school?

Yes
No

Are you or have you been a foster child or ward of the state?

Yes
No

Have you ever been convicted of a felony or misdemeanor?

Yes
No

Have you been treated for drug or alcohol dependency?

Yes
No

Are you homeless?

Yes
No

Are you working?

Yes
No

If yes, what was your start date?

How many hours do you work per week?

What do you make per hour?

Do you have a disability?

Yes
No

If yes, how does it affect your employment?

Please list any special needs (if none, indicate "none" below):

Marital Status

Residency (who lives with you):

Family Status

List the names, ages, and relationship to you of those in your household that are related to you:

Have any member of your household received any of the below in the last six months? (Check all that apply.)

Veteran's benefits
DHS cash assistance
Pensions
Food stamps
Annuities
Unemployment
Odd jobs (cash)
Social security
Child Support
Alimony

The information above is correct to the best of my knowledge and there has been no attempt to commit fraud.

Joliet Junior College
1215 Houbolt Road, Joliet, IL 60431-8938
Phone: (815) 729-9020

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