UPLIFT NORTHWEST RISE PROGRAM APPLICATION

Uplift NW RISE Program Application

Roadmap to Independence & Sustained Employment

DEADLINE: JANUARY 6, 2025

Uplift Northwest is pleased to announce the launch of a new, comprehensive job training program designed to address essential needs while providing you with the necessary skills to thrive in the workplace. While completing training, you will receive various support services based on your needs to ensure you are set up for success. As part of the RISE program, there are four weeks of MANDATORY training. Each week focuses on a different theme: Personal Development, Emotional Resilience, Collaborative Skills, and Workplace Navigation.

Please check that you meet all the program requirements.

I am 18+ years of ageI understand that a staff member will let me know by Wednesday, December 8th, if I made it into the next job training cohort.If I am accepted, I can attend orientation on Friday, January 10th, 2025.I am available to train Tuesday through Friday, 9:00AM to 1:00PM for 4 weeks (January 14th to February 7th).I understand that attendance, participation, and/ or behavior can impact the graduation package I receive at the end of training.I understand that I will not be able to join the Uplift Northwest staffing agency until RISE job training is complete.

How did you hear about Uplift Northwest?

Do you have a referral?

YesNo

For what program?

Legal First Name

Middle Initial

Legal Last Name

Suffix

Preferred Name

ex. Nickname

What are your pronouns?

Other

Gender

Other

Sexual Orientation

Other

Date of Birth

MM/DD/YYYY

Country of Birth

Primary Language

Other

Race

Other

Marital Status

U.S. Military Veteran Status

Mobile Phone

PERMISSION TO TEXT (Optional)
By initialing here, you’re signing up to receive SMS text communications from Uplift Northwest. You consent to receive information about job opportunities and resources from Uplift Northwest at the number provided. Msg & data rates may apply. Msg frequency varies. For help reply HELP, to opt out reply STOP. View Terms of Service and Privacy Policy by visiting https://www.upliftnw.org/terms-of-conditions-privacy-policy/

AgreeDisagreeI prefer not to answer (N/A)

Mailing Address

Enter the address you are comfortable sending your mail to. The mailing address needs to be located in Washington state.

Please type mailing address below. If you do not have a mailing address, you can use the Compass Center address (77 S Washington St, Seattle, WA, 98104).

Mailing Address Line 1

Mailing Address Line 2

Apartment Number

City

State

ZIP Code

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

What is your current housing situation status?

Other

Do you care for any children in your household?

How many?

Do you live with any dependents?

How many?

Do you have dependents in your household over the age of 18?

Do you have reliable childcare during the training period, Tuesday - Friday, 9:00AM to 1:00PM for the next 4 weeks?

Do you have a checking and savings account?

What health insurance do you have?

Do you have any disabling conditions that require special accommodations? (For example, use a wheelchair, asthma, schizophrenia spectrum, hearing loss, etc.?

Please explain how we can best accommodate you?

Have you ever been impacted by the legal system?

Have you ever been convicted of a crime?

Do you have a way to get to work?

Have you every applied for a job?

Have you ever interviewed for a job?

Do you have a LinkedIn profile?

Are you currently enrolled in school?

Are you currently employed elsewhere?

Have you worked in the last 5 years?

Employment History

Job Title

Job Responsibilities

Date Started

Date Ended

Hourly Wage

What is the highest level of education you completed?

Do you have professional licenses that are currently valid?

Name the list of current professional licenses:

What are your short-term and long-term employment goals?

What is currently preventing you from achieving your short-term/ long-term employment goals?

Other

POLICIES & AGREEMENTS (REQUIRED)

As both an Uplift Northwest employee and a RISE trainee, you are required to adhere to all mandatory policies and agreements.
Please write your full name below to acknowledge your understanding.

TERMINATION POLICY
While we hope your employment with us will be mutually rewarding, the length of employment is not for any fixed term and may be terminated either by you or Uplift NW, at any time, for any reason, with or without notice or cause.

Conduct that interferes with the operations, brings discredit to Uplift NW, or is offensive to customers or fellow workers will not be tolerated whether it occurs on or off Uplift NW time or property. All workers are expected to conduct themselves professionally and behave in a manner that is conducive to the efficient operation of Uplift NW.

If your performance or behavior is not meeting our expectations, Uplift NW may use a number of steps to address the issues. You will be expected to follow through on the determined course of action.

Examples of Reasons for Termination: Abusive language toward staff, other workers, and/or employers; threats, violence, or inciting violence; falsifying a time sheet; asking for cash on a job or renegotiating wages; one no call/no show (NC/NS) to a job

I agree

DRUG AND ALCOHOL-FREE WORKPLACE POLICY
Uplift NW is committed to maintaining a drug and alcohol-free workplace to protect against the serious risks posed by manufacturing, distributing, dispensing, possessing, or using alcohol or any controlled substances, and therefore prohibits all such activities. Such activities threaten and impair worker health, safety, security, morale, and job performance. Absolutely none of these activities can occur at Uplift NW's facilities, on employer worksites, at any other time while on the clock for Uplift NW, or during associated travel time. This includes medical marijuana.

If you are taking prescription drugs that may affect your ability to work safely, you should notify your Uplift NW supervisor or Human Resources of the possible side effects and obtain permission before beginning work.

Failure to adhere to the provisions of this policy will result in disciplinary action, including potential termination.

I agree

DRESS AND GROOMING STANDARDS
It is in both Uplift NW's and the worker’s best interest to present a professional image to employers and to the public by being suitably groomed, and having a neat and clean appearance. Anyone entering our Work Training Program must ensure that their dress is appropriate for the situation in which they are working (always be prepared for changing weather conditions) and that they present a professional image. It is expected that all participants will dress in a manner consistent with good hygiene and safety.

Body:

• Offensive body odors could keep you from being sent to work.

• Showering and using deodorant daily is essential.

• Daily oral hygiene is essential.

Clothing:

• Clothes must be clean without an offensive odor and must have a neat, professional appearance

• Clothes must be appropriate for the assigned jobs.

• Shoes must be closed toed and acceptable for the assigned work. Boots or heavy soled shoes are preferred for manual labor.

• Baseball caps may be worn, but must have a neat and professional appearance with the bill facing forward.

Accessories:

• Wristwatches, wedding rings, and jewelry with religious significance may be worn.

• All other jewelry is prohibited. This includes large earrings, bracelets, multiple rings on each hand, and exposed jewelry around the neck.

I have reviewed Uplift Northwest’s policies and agreements, and by signing below, agree to adhere to all of them.

I agree

POLICIES & AGREEMENTS (OPTIONAL)

RELEASE OF CONFIDENTIAL INFORMATION
I hereby authorize Uplift NW to release information from my employment record to potential employer, housing providers, and government assistance programs for the reason(s) specified. I acknowledge by my signature that I understand that although I am not required to release my information, I am giving my consent to do so. Additionally, I understand that I may revoke this authorization in writing at any time, except for that information which has already been released with consent. (Confirmation of authorization from workers over phone, email, or text are not valid forms of confirmation.)

AgreeDisagreeI prefer not to answer

AUTHORIZATION FOR EMERGENCY TREATMENT
This grants Uplift NW permission to request emergency medical treatment for your health, including hospitalization.

AgreeDisagreeI prefer not to answer

PHOTO/ MEDIA RELEASE
This grants Uplift NW the right to use, reproduce, and/or distribute photographs, films, videotapes, and sound recordings involving you. Our Marketing Department could use the media for our website, blog, or other media purposes.

AgreeDisagreeI prefer not to answer

ACKNOWLEDGEMENT

I certify that the information provided in this application is true to the best of my knowledge. I am also aware that the information I have provided is subject to review and verification and I may have to provide additional documentation to enroll. I understand that I will need to provide my proof of employment eligibility documents (For example, state ID and Social Security Card) to enroll. I allow release of this information to Uplift Northwest staff for verification purposes and for background checks. I understand that receiving services is subject to availability of government funds and that providing false information may result in termination from Uplift Northwest.

Please type your full legal name below to indicate acceptance of above agreement and submit the application.

Little/ No Rental History	Eviction
Large Family (3+ children)	Single Parent Household
Sporadic Employment History	Insufficient Income
No Credit	Poor Credit
Debt	Repeated/ Chronic Homelessness
Recent History of Substance Abuse	Actively Using Drugs and/or Alcohol
Recent History of Abuse/ Domestic Violence (Abuser is no longer present)	Currently Experiencing Abuse/ Domestic Violence (Fleeing DV)

SNAP	TANF
WIC	SSDI
SSI	ABD
Child Support	Alimony
I would like assistance determining eligibility for SNAP	None