Concrete Certification Registration

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Concrete Certification Registration

Welcome to LITE!

We are excited to help you get started on a great career.

We are working with the concrete industry to offer opportunities for careers in high paying positions.

Let's get started!

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Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

What is your Birth date? *

Please indicate how you prefer to be identified *

Male
Female
Non-Binary
Prefer not to answer

Please identify your race *

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Do you have Hispanic or Latino ethnicity? *

Yes
No

What language do you feel most comfortable speaking?

Parent or legal guardian name *

First

Last

Parent or other significant adult phone number *

Parent or other significant adult email address *

What is the primary language spoken by your parent/other significant adult?

What is your education status? *

High school freshman
High school sophomore
High school junior
High school senior
Graduated high school
G.E.D.
Some college
Graduated college
Not in school

What is your employment status *

Working part time
Working full time
Looking for work
Not looking for work

If you are working now is this your first job? (if yes, please write yes in the box, if not please list your last 3 jobs and how long you worked at that job.) *

Describe your dream job?

Do you have transportation? *

Yes
No

Check all the services that would best help you. *

Skills for Life (Earn while you learn, build the skills that will help you manage your career path, education path, finances, and positive relationships)
Career Exploration (learn about careers by doing hands-on exploration, meeting with professionals, and completing projects)
Work Experience (Earn while you learn the skills needed by employers, demonstrate skills while you work to build your portfolio, learn how to connect your skills with interviewing and resume building)
Positive Recreational Activities (Participate in arts and cultural activities, recreational activities as you learn how to manage positive social relationships, earn passes to special events)
Employment (career readiness, resume building, job placement and career building)

Please provide a brief statement about your situation. What do you want to achieve by participating in LITE services? *

Is there any additional information for us to know in order to help you achieve your goals? *

How did you hear about LITE?

"Consent for Promotional Purposes – permission to Leaders In Transformational Education (LITE) to use artwork, writing or pictures/videos taken at this event for the promotional purposes. I understand that refusal to sign this release will not affect delivery of service in any way. I am 18 years old or older/ I am a parent or guardian of a child under 18 years of age *"

Yes
No

"All participants must Sign: I understand and agree to any policies, notices, and procedure regarding transportation provided by my organization and that I must arrive with and leave with the same transporter. At no time will I leave an event with an unauthorized person. I / my child will stay with the group while at the event and be at designated pick up and drop off locations at the assigned time. I understand and do not hold any representative of (LITE) responsible for accidents or injuries in the event an unforeseen incident occurs and that me / my child agree to abide by the rules set for transporting. In the event the rules are not abide by, LITE may refuse to allow me / my child from participating in future off-site events. LITE will only provide transportation for LITE clients that are registered and active in LITE programming, If you are not a registered and active LITE client you / your child must secure your own transportation. If offered I agree to the above and give permission for me/ my child to take the transportation offered to the above mentioned event". Participants 18 years or older, please sign below. Participants under the age of 18, please have a parent/legal guardian sign below.

"I/my child does not have a medical condition that I am aware of that prevents me / my child from participating in this activity. I agree to hold Leaders In Transformational Education (LITE) and any of its officers, employees, or volunteers free from any and all liability and waive all claims of dam- ages or recompense for any accident, injury or disability to me or my property arising out of or connected with my participation in this activity/outing. I also authorize the Chief Executive Offi- cer of (LITE), or duly designated representative, to secure the necessary medical, hospital and surgical attention, in the event of illness or physical injury to me/ my child during participation in this activity. By providing your signature below you have read and agree to the statement above. *Participants under the age of 18, please have a parent/legal guardian sign below.

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