Incumbent Worker Training Course Intake Form              Earn Maryland Logo


Civic Works’ Center for Sustainable Careers offers grant-funded incumbent worker training classes, with the mission of helping the industry grow and supporting the career advancement of workers. This class is funded by the Maryland Department of Labor, the U.S. Department of Labor, and local foundations. All demographic and employment information collected is kept confidential and is required to participate in the training under these grants. 










Training Participant Agreement

This class is funded by the Maryland Department of Labor, the U.S. Department of Labor, and local foundations. Civic Works' ability to continue offering free and subsidized training depends on participants’ commitment to attending classes regularly and putting forth their best effort.

By signing up for this course, I commit to the class requirements below:

  1. Provide full and accurate information on the application form.
  2. Certify that you are a resident of the State of Maryland (non-Maryland residents are not eligible to have the cost of training covered under the EARN Maryland program)
  3. Attend each and every day of the training. Punctuality and full attendance are expected. If you who miss class, you will be asked to make up the material before taking the test.
  4. If you do not initially pass the test, work with Civic Works to re-take the class and test (at no cost).
  5. Share your test scores directly with Civic Works.
  6. Authorize your employer to share your post-training wage and benefit information.
  7. This is a virtual course and access to a computer with a camera is a course requirement. 


Your signature will be collected upon application submission.

Answer questions completely except for those which do not apply. Information is kept confidential. By enrolling in this program, I grant permission to share my information with Civic Works and the U.S. Department of Labor, Maryland Department of Labor, and other third parties. This program reserves the right to check the accuracy of the information below. 


08/08/2026
CONTACT INFORMATION




All communication will be sent via email. Please provide an updated email address that you check often.


By entering your number above, you agree to receive text messages from Civic Works' Center for Sustainable Careers staff related only to your application/interview process and if enrolled, any relevant information we need to share. Standard message & data rates may apply. Message frequency varies. Reply HELP for help and STOP to cancel. Privacy Statement
ADDRESS






Maryland residents: choose your county of residence. Non Maryland residents: choose your state if there, otherwise select 'Other'.

SECTION I: DEMOGRAPHIC BACKGROUND












SECTION II: MILITARY BACKGROUND




Select Yes <= 180 Days if the participant is a person who served in the active U.S. military, naval, or air service for a period of less than or equal to 180 days, and who was discharged or released from such service under conditions other than dishonorable.
Select Yes, Eligible Veteran if the participant served on active duty for a period of more than 180 days and was discharged or released with other than a dishonorable discharge; or was discharged or released because of a service connected disability; or as a member of a reserve component under an order to active duty pursuant to section 167(a), (d), or (g), 673 (a) of Title 10, U.S.C., served on active duty during a period of war or in a campaign or expedition for which a campaign badge is authorized and was discharged or released from such duty with other than a dishonorable discharge.
Select Yes, Other Eligible Person if the participant is: (a) the spouse of any person who died on active duty or of a service connected disability, (b) the spouse of any member of the Armed Forces serving on active duty who at the time of application for assistance under this part, is listed, pursuant to 38 U.S.C 101 and the regulations issued there under, by the Secretary concerned, in one or more of the following categories and has been so listed for more than 90 days: (i) missing in action; (ii) captured in the line of duty by a hostile force; or (iii) forcibly detained or interned in the line of duty by a foreign government or power; or (c) the spouse of any person who has a total disability permanent in nature resulting from a service connected disability or the spouse of a veteran who died while a disability so evaluated was in existence.

SECTION III: EDUCATIONAL BACKGROUND

SECTION IV: EMPLOYMENT INFORMATION



Please type full employer name.












CONSENT FOR COLLECTION AND RELEASE OF PERSONAL INFORMATION

This class is funded by the Maryland Department of Labor and the U.S. Department of Labor, which require Civic Works to collect and submit performance reporting data that will includes personal and employment records to demonstrate program effectiveness. Civic Works will collect and retain participant personal and employment records for internal purposes and, as necessary, for release to third parties. By reading and signing this release form, I agree to the following terms and conditions of my participation in Civic Works’ training program.

Please read each term below:

1. I authorize Civic Works to verify my income covering the time periods prior to enrollment, during enrollment, and after program completion using information in state and federal electronic databases and databases from the Internal Revenue Service, and/or a consumer reporting agency.

2. I authorize Civic Works to verify, confirm and store my personal information. This personal information includes, but is not limited to, my name, age, date of birth, race, income, social security number, address, and other identifiable information which will otherwise be confidential.

3. I authorize Civic Works to release my personal information to third parties to satisfy funding requirements from organizations which have funded my training at Civic Works, to assess program effectiveness, and for specific case management referrals.

4. I understand that Civic Works will request that the recipients of my personal information will keep it confidential, but Civic Works cannot guarantee that these recipients will do so.

5. I understand that I must inform Civic Works staff of any corrections or changes to the above information, and that Civic Works will correct its records as requested.

Contact Information