Riverview GardensAdult Culinary Program Application

Contact Information

Name *

First

Last Name *

Last

Birthday

Email

Phone

Address

City

State/Province

Zip/Postal

Work Experience

In a few short sentences, please tell us what brings you to Riverview Gardens and what are your goals for future employment?

Are you currently employed? If so, what is the name of your employer, your current wage, and the number of hours you work each week?

What kind of jobs have you had in the past? Please share some of your work history, including any kitchen or restaurant experience.

What (if any) barriers do you face in maintaining stable employment?

Education Background

Highest Level Completed

Demographic Information

Gender

Male

Female

Other

Prefer not to say

Preferred Pronouns

He/Him/His

She/Her/Hers

They/Them/Theirs

Other

Race / Ethnicity

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Two or More Races

Prefer not to say

Have you ever served on active duty with the U.S. Military, National Guard, or Reserves?

Yes

No

Do you have any foodborne allergies? *

Yes

No

Describe Allergies

Do you have any disabilities? *

Yes

No

Describe disabilities:

How did you hear about us?

Emergency Contact

Name *

First

Last Name *

Last

Phone Number *

Program Requirements

I am 18+ years of age.

I experience barriers to employment and/or are considered low income.

I am available to train for up to 6 hours a day, Monday through Thursday.

I can work in the U.S. and have valid identification for employment.

Release of Information Authorization (Electronic Consent)

I authorize Riverview Gardens to release and/or obtain information necessary to support my participation in the Adult Culinary Program. This may include communication with referring agencies, probation or parole officers, social service providers, employers, educational institutions, case managers, and other relevant support professionals. Information shared may include attendance, participation, program progress, completion status, employment readiness, and other updates related to my involvement in the program. I understand: This authorization is voluntary. I may revoke this authorization at any time by submitting a written request to Riverview Gardens, except to the extent that action has already been taken based on this authorization. This authorization remains in effect for the duration of my participation in the program unless revoked in writing. Information may be shared electronically (including email or secure digital platforms) for program coordination and support purposes. By checking the box below and typing my name, I acknowledge that I have read and understand this authorization and agree to its terms. I understand that my electronic signature is legally binding.

I Agree to the Release of Information

Type Full Legal Name

Date