Highway Construction Careers Training Program (HCCTP) Application

Direct questions regarding this application to the program coordinator at 618-985-2828, ext. 8643.

Name

First Name:

Last Name:

Address

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

County of Residence:

Email:

Confirm Email:

(Email will be the primary method of communication so be sure to check your spam folder.)

Date of Birth:

(Candidates must be at least 18 years of age by the first day of class.)

Gender:

U.S. Citizen:

Ethnic Background:

If you chose "Other" please put your ethnic background here:

Do you have a valid driver’s license? 

(Candidates invited to interview must present their valid driver’s license.)

License Number:

State of Issuance:

License Expiration Date:

Attendance

This program has a strict attendance policy. Missing class, being tardy, and/or leaving early can lead to expulsion. Candidates are expected to have reliable transportation and childcare if needed.

Are you able to attend class Monday–Friday, 7:00am–3:30pm during the 12-week program?

Do you have reliable transportation?

If needed, have you made childcare arrangements?

Education

Candidates invited to interview will be required to provide documentation for the highest level of education indicated below.

Education Level

(Candidates must have a high school diploma or GED by the first day of class.)

Select the highest level of education you have obtained:

Describe the degree/license/program for the box you checked:

Are you presently in school or an educational program? 

If you chose "Yes" please put the name of school or program here

Have you participated in other related training programs?

If yes, please list the length of time in the training and a description of the training below:

HCCTP Experience

Have you previously applied to the HCCTP?

If yes, where and when?

Have you previously been accepted into HCCTP?

If yes, where and when?

Employment History

What is your current employment status?

If you are currently employed, provide your current occupational field, place of employment, and job title:

List any other jobs held or work performed that may be related to the Construction Industry:

Income

The following income information is voluntary and will not affect consideration for your admission into the program.

What is your current household income level?

List Sources of Income:

Indicate the number of dependents under the age of 18 living with you in your household:

Indicate the TOTAL number of occupants in your household

Criminal Background

Candidates considered for admission to the program will undergo a background check. Candidates indicating a criminal background may be contacted to provide more information. Candidates convicted of a “Forcible Felony”, as defined by Illinois Statute (720 ILCS 5/2-8) (from Ch. 38, par. 2-8), will not be considered for the program.

Have you ever been convicted of a misdemeanor?

Name under which the conviction was recorded:

County in which the conviction occurred:

Date of the conviction:

Description of the conviction:

Have you ever been convicted of a felony?

Name under which the conviction was recorded:

County in which the conviction occurred:

Date of the conviction:

Description of the conviction:

Share any work experience that related to the construction industry. This can include such things as minor repairs to a home, use of hand tools, servicing your car, etc. 

Give your specific reasons for wanting to enroll in this class. List what you want to accomplish during and after the course is over.

In regard to this program, what else you would like to share about yourself?

If you have a disability requiring special attention, please describe:

References

Reference 1 of 2

First Name:

Last Name:

Relationship (parent, spouse, significant other, employer, etc.):

Phone Number:

Email:

Reference 2 of 2

First Name:

Last Name:

Relationship (parent, spouse, significant other, employer, etc.):

Phone Number:

Email:

REQUIRED DOCUMENTS

Candidates invited to interview must present the following documents.

APPLICANT AGREEMENT

• I understand that to be eligible to participate in this program, I must:

1) be 18 years of age

2) have a high school diploma or GED

3) possess a valid driver’s license

4) pass a background check (Candidates convicted of a “Forcible Felony”, as defined by Illinois Statute (720 ILCS 5/2-8) (from Ch. 38, par. 2-8), will not be considered for the program).

5) consent to and successfully pass drug screenings

• I understand and agree that the information I have provided is accurate to the best of my knowledge with no intent to commit fraud. Any misrepresentation or deliberate omission may be grounds for termination from this program.
• I understand that this information will be kept confidential and will not be released to the public. I have been advised that this information will be kept on file for one year and may be shared with other authorized agencies for the purpose of administering programs of these agencies.
• I understand that I have the right to inspect this information and initiate appropriate corrections through the agency to which I am providing this information.

NOTICE: The Illinois Dept. of Transportation, the Illinois Community College Board and the participating community colleges do not guarantee employment upon a trainee’s graduation from the Highway Construction Careers Training Program

By clicking submit, I understand and agree to the statements above.