Name
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First Name
Last Name
Email
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Date of Birth
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Phone
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(###)
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####
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact: Name, phone number and relationship to contact
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Are you currently in recovery from substance use disorder? Yes / No
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How long have you been in recovery?
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Are you participating in a structured recovery program? Yes / No - If yes, name of program & contact person & phone number
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Do you have a mentor or recovery support person? Yes / No - If yes, name & contact information
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Are you currently living in a sober living residence? Yes / No - If yes, name of house & location, contact person (Manager/Owner) & phone number. How long have you been there? How long do you intend to stay?
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What is your long-term sobriety plan? (Briefly explain your strategy for maintaining long-term recovery).
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Employment & Training Goals: No prior experience in the trades is necessary to apply. Have you previously worked in a trade or skilled labor position? Yes / No - If yes, what trade(s) and for how long?
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Do you have any experience with carpentry, construction, or similar work? Yes / No - If yes, describe.
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What are your employment goals after completing this program?
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Are you currently employed? If so, what is your weekly pay?
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Do you have any physical limitations that might affect your ability to perform construction work? Yes / No - If yes, please explain.
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Legal & Transportation Info: Do you have a valid driver’s license? Yes / No
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Do you have access to reliable transportation? Yes / No
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Have you been convicted of a felony or misdemeanor? Yes / No - If yes, please explain (Note: Prior convictions do not automatically disqualify you from the program).
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Commitment & Availability • Are you able to commit to a 12-week training program? Yes / No
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Are you available one evening per week for a three-hour class? Yes / No
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Are you available during the day on Saturdays? Yes / No
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Are you willing to follow all program rules, including maintaining sobriety throughout the course? Yes / No
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Additional Information: Why do you want to join the Skilled Purpose program? (Briefly explain in 2-3 sentences).
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Is there anything else you’d like us to know about you or your situation?
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References: Please provide at least one reference who can speak to your commitment to recovery and reliability. This could be a mentor, case manager, employer, or another trusted individual. Please provide their name, phone number and your relationship to them.
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Signature & Acknowledgment: I certify that the information provided in this application is true to the best of my knowledge. I understand that acceptance into the Skilled Purpose program is contingent upon meeting eligibility requirements and agreeing to all program rules.
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