Application Part 2 - AARP WorkSearch

AARP FOUNDATION
Web Based SCSEP Application Form
Welcome to Part 2: Background
DIRECTIONS: The first step was to determine if you are eligible for AARP Foundation SCSEP services. Now
that you have been determined eligible, please complete the Background Application so that we can learn
more about you and determine if you are a suitable candidate for enrollment. When you have completed all of
the pages of the Background Application, submit all pages of the application for review to the appropriate
location listed on the website: http://cms.aarpworksearch.org/Pages/VirtualSCSEP.aspx
Applications can be submitted via Mail, Fax, or as attachments to an Email. NOTE: Incomplete
applications that are submitted will NOT be reviewed. You will receive an email response once your
application of eligibility has been reviewed. Please allow up to 5 business days for a decision regarding your
application for Eligibility. If determined suitable, your next step will be to complete and submit part 3 of the
application.
Applicant’s Name:
TELL US ABOUT YOURSELF
Are you: Disabled Severely Disabled Frail Do you have Limited English Skills Yes No
Veteran Yes No Spouse of a Veteran Yes No Are you Homeless Yes No
Please check all of the following that describe your situation:
I am behind on my rent or mortgage
I do not consider myself homeless, but I share space with a family member or close friend (in their name). This is not a permanent
arrangement and is not my preference.
I have involuntarily moved several times over the last year.
My credit history disqualifies me from completing most rental/lease agreements.
My background disqualifies me from completing most rental/lease agreements.
Without additional income, I cannot pay my rent/mortgage most months.
I frequently have electric/gas/water bills that are unpaid or overdue.
I have previously been evicted from a residence in the last 12 months.
I have lived in a shelter at some point during the past 12 months.
I often borrow money to help pay my rent/mortgage.
I live in my own home, but my real estate taxes are unpaid or overdue.
1
Revised: 9/21/2011

AARP FOUNDATION
Web Based SCSEP Application Form
Part 2: Background
TELL US ABOUT YOURSELF (CONT.)
What forms of Transportation do you usually use? (Check All That Apply)
Car Bus Train Subway
Cab Walk Bike Other
What is Your Availability to Work: Part Time Full Time Both
Work Preference: Part Time Full Time
Earliest in A.M. Latest in P.M. Can you work Saturdays? Yes No Can you work Sundays? Yes No
List any Geographical areas in your community that you are willing to work: (Example: List Different Towns or Cities or Parts of a City)
1) 2) 3)
4) 5) 6)
Briefly describe what your goals are if you were enrolled into AARP Foundation SCSEP?
What do you think you need from AARP Foundation SCSEP to help you reach your goal?
How long do you think it will take to find a job?
List at least 3 job titles that you are looking for:
1) 2) 3)
4) 5) 6)
2
Revised: 9/21/2011

AARP FOUNDATION
Web Based SCSEP Application Form
Part 2: Background
Applicant’s Name:
PREVIOUS EMPLOYMENT
Company Phone ( )
Address
Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
Company Phone ( )
Address
Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
Company Phone ( )
Address
Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
EDUCATION
High School
Address
From
To
Did you
graduate?
YES
NO
Degree
College
Address
From
To
Did you
graduate?
YES
NO
Degree
Other Address
From
To
Did you
graduate?
YES
NO
Degree
3
Revised: 9/21/2011