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Jobs Initiative Application

If you wish to apply for the Jobs Initiative as approved under the $190M SPLOST initiative, please complete the following. Your information will be forwarded to the appropriate agencies.

Full Name:
Street Address:
City:
State:	GA
Zip:
Email:
Telephone:
Age (must be 17-25):
Date of Birth (MM/DD/YY):
Last 4 digits of Social Security No.:
Have you ever been convicted of a felony?	Yes No If yes, explain:
Please state work experience and/or special skills which would qualify you for this program: