Washington County Skill Center Online and Printed Application

If you are interested apply for admission for one of our programs you can download and print out our PDF application by clicking here or fill out our online application by filling in the information below and clicking submit. After you submit your application, you will recieve a confirmation e-mail from one of our staff members.

If you have any problems with either application or if you have questions, please contact us by e-mail at info@wcskillcenter.org or by phone at 276-676-1948.

Training Program Interest: First Choice * Administrative Support Specialist CNC/Machining Dental Assistant Diesel Truck Technician Industrial Welding Medical Assistant

Training Program Interest: Second Choice Administrative Support CNC Machining Dental Assistant Diesel Truck Technician Industrial Welding Medical Assisting

Last Name: *

First Name: *

Middle Name

Address: *

City: *

County

State: * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming --U.S. Territories-- American Samoa Federated States of Micronesia Guam Midway Islands Puerto Rico U.S. Virgin Islands

Zip: *

Date of Birth * 123456789101112 / 12345678910111213141516171819202122232425262728293031 / 20122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903

Phone: *

Cell Number:

E-mail Address: *

Emergency Contact (Include name and phone) *

Secondary School * High School Diploma GED Program Home Schooled Other

Secondary School Name & Graduation Date *

If non-graduate, select highest grade completed N/A or Other89101112

Vocational Area of Study

Have you ever been convicted of a felony? * Yes No

If convicted of felony, indicate nature of offense. If no put N/A in box. *

Are you a veteran? Yes No

Colleges or Technical Schools Attended (list dates enrolled)

Referring Agency, Counselor Contact Info

If you earned a college degree, please list the major:

Previous Employer #1:

Dates Employed:

Job Title 1

Supervisor Name:

Job Duties at Previous Employer:

Job 1 Wages

Previous Employer #2:

Dates Employed:

Job Title 2:

Job Duties at Previous Employer:

Wages

Additional Information:

Application Online Signature (Type your full name) *

Date of Application

Available Start Date: *

* Required Create Email Forms

© 2012 Washington County Skill Center
848 Thompson Drive • Abingdon, VA 24210 • (276) 676-1948 • 1-866-676-1948