Apply for a Job at Prairie Lanes in Sun Prairie, WI

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First Name

Middle Name

Last Name

Birth Date

Address

County

State

City

Zip Code

Email

Phone

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Are you a veteran of the US Armed Force?

Yes

No

Branch* Select a branch

Enlistment Date*

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Discharge Date*

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Were you unemployed for a combined period of at least 6 months(whether or not consecutive) during the previous year?

Yes

No

Were you unemployed for a combined period of at least 4 weeks but less than 6 months during the previous year?

Yes

No

Are you a member of a family that received Supplemental Nutrition Assistance Program (SNAP) benefits (food stamps) for at least 3 months during the last 5 months?

Yes

No

Unsure

Enter the first name of the primary recipient* First Name is required. greater than 3 words required .

Enter last name of the recipient* Last Name is required. greater than 3 words required .

Enter the city where the benefits were received* City is required. greater than 3 words required .

Enter the state where the benifits were received* Select a state

Are you a veteran entitled to compensation for a service-connected disability?

Yes

No

Were you discharged or released from active duty within the last year?

Yes

No

Were you referred to an employer by state funded vocational or veteran's rehabilitation program?

Yes

No

Were you referred to an Employer by:

A Vocational Rehabilitation Agency approved by a state Please check the checkbox

An Employement Network under the ticket to work program

The department of veteran affairs

None of the above

Were you convicted of a felony or released from prison after a felony conviction during the past year?

Yes

No

Enter the date of conviction*

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Enter the date of release*

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Was this Federal or State Conviction?

Federal Need to Select

State Need to Select

Did you receive supplemental security income (SSI) benefits for any month ending during the past 60 days?

Yes

No

Unsure

Have you been unemployed for 27 consecutive weeks during the last 12 months?

Yes

No

Unsure

Have you received unemployment compensation in the last 12 months?

Yes

No

Unsure

First day of unemployement?*

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Last day of unemployement?*

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Authorization

I authorize the Department of Veterans affairs, Rehabilitation and correction, Vocational Rehabilitation, or social security Administration for SSI to provide the verification or information requested by StaffedUp solutions or the State Workforce agencies and release the information to those entities as requested. Please check the checkbox

Under penalties of perjury,I declare that I gave the above information to the employer on or before the day I was offered a job, and it is, to the best of my knowledge, true, correct, and complete. Please check the checkbox

Full Name*

Social Security Number* Security number required Security number digit must be 5 Please enter digit only !

Date of Birth*

Current Date

Veteran

Details

I'm a veteran & I was unemployed for a period totaling at least 6 months during the past year.

SNAP recipient

Details

I'm at least age 18 but not over 40, & I am a member of a family that: a. Received SNAP benefits (food stamps) for the past 6 months b. Received SNAP benefits (food stamps) for at least 3 of the past 5 months, but is no longer eligible to receive them.

Prairie Lanes Job Opportunities

Veteran

SNAP recipient

TANF recipient

Ex-Felon

Long-Term Unemployed

SNAP Veteran

Vocational rehabilitation

Supplemental security income (SSI)

Prairie Lanes Job Opportunities

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Applicant Information

Veteran Information [[event.applicant ? event.applicant.name + ' - ' + event.application.position : '']]

Supplemental Nutrition Assistance Program

Temporary Assistance For Needy Families (TANF)

Conditional Certification

Criminal Record [[event.applicant ? event.applicant.name + ' - ' + event.application.position : '']]

Supplemental Security Income (SSI)

Long-Term Unemployment [[event.applicant ? event.applicant.name + ' - ' + event.application.position : '']]

Verification

Authorization

Previous Employer

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Veteran

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TANF recipient

Confirmation

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Ex-Felon

Long-Term Unemployed

SNAP Veteran

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Vocational rehabilitation

Supplemental security income (SSI)

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Veteran Information
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Criminal Record
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Long-Term Unemployment
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