HUMANITY'S KITCHEN CULINARY TRAINING PROGRAM APPLICATION

    The information provided here will be used by Humanity’s Kitchen staff to better understand each potential trainee’s situation and needs.
    All information will be kept confidential.

    Are you a citizen of the United States?
    YesNo

    If no, are you authorized to work in the United States?
    YesNo

    All instruction for this program is conducted in English. Are you able to read, write and communicate effectively in English?
    YesNo

    REFERRAL INFORMATION:

    Have you been enrolled in this program before:
    YesNo

    EDUCATION:

    WORK HISTORY:

    (Please provide complete information on your last three jobs, starting with the most recent one.
    Note: Food service experience is not a requirement for admission to the program)

    Dates of Employment

    Dates of Employment

    Eligibility Requirements for Admission to Humanity’s Kitchen

    Applicants must:
    1. Be 17 years of age or older.
    2. Have reading and math skills at a 7th grade level. Exceptions can be made on a case by case basis.
    3. Not be a danger to self or others.
    4. Be available to be in class from 9:00am to 3:00pm Monday through Thursday. Able to attend class every day on time.
    5. Be available for any special events that Humanity’s Kitchen hosts.
    6. Be curious, ready to learn, and willing to do homework.
    7. Be interested in, and have a strong desire to work in the Hospitality Industry.
    8. Be able to read, speak, and comprehend English in a fast paced environment.
    9. Have basic math skills and an adequate reading level for studying a textbook, completing exams, and writing job related documents.
    10. Able to lift 20 pounds and stand up to 6-8 hours daily with or without a reasonable accommodation. Exceptions can be made on a case by case basis.
    11. Be able to see well enough to read at 2.5 feet with or without reasonable accommodations. Exceptions can be made on a case by case basis.
    12. No violent or sexual criminal history. (This means murder, or on sex offenders list)
    13. You must pass a drug test, and participate in random tests.

    Please read the above criteria carefully. If you are able to meet these criteria, please sign and date below

    Student Signature:

    Date:

    Signature of Parent/Guardian if under age of 18

    SOCIAL SERVICES INFORMATION

    Do you have a Case Worker/Case Manager/Counselor:
    YesNo

    Do you have a source of income
    YesNo

    What is your actual source of income?

    Are you receiving assistance from:

    Food Stamps
    YesNo

    Cash Assistance
    YesNo

    SSI
    YesNo

    Unemployment benefits
    YesNo

    Are you the head of the household
    YesNo

    Ages of children in household

    Are you currently living in a transitional home or shelter?
    YesNo

    Do you have a secure place to live for the next three months while in the program?
    YesNo

    What means of transportation will you use for the next three months to get to the program on time every day?

    BusCarParatransit

    Are you currently or ever been involved in any type of drug or alcohol rehabilitation program?
    YesNo

    Are you a veteren?
    YesNo

    Do you have any regular ongoing appointments?
    YesNo

    BACKGROUND INFORMATION

    Have you ever been convicted of misdemeanor or felony?
    YesNo

    Do you have a Parole/Probation Officer?
    YesNo

    Do you have any court cases or legal issues pending?
    YesNo

    IN CASE OF EMERGENCY

    Do you have a doctor?
    YesNo

    Name and phone number:

    Are you currently taking any prescription medication?
    YesNo

    Do you experience any side effects, such as drowsiness, impaired motor skills, or impaired judgment when taking these medications?
    YesNo

    Do you have any medical condition(s) that will interfere with lifting 40 pounds or standing for 6 hours?
    YesNo

    Have you been diagnosed with Hepatitis A?
    YesNo

    Are you HIV positive?
    YesNo

    REFERENCES

    Please list two references who are not relatives or previous supervisors. These should be individuals who have known you well for 1 year or more.

    TRAINING REQUIREMENTS

    Listed below are some of the program requirements. Please initial after each one that you agree to each requirement.

    • Listed below are some of the program requirements. Please initial after each one that you agree to each requirement.

    • I understand that I must be on time and prepared to stay the entire day.

    • I understand that I must be willing to accept instruction from my instructors and complete the tasks that are assigned to me with a positive attitude.

    • I understand that I must be clean and sober.

    • I understand that Humanity’s Kitchen is not responsible for damage, loss, or theft of my personal property.

    • I understand that this campus is a nonsmoking campus

    DISCLAIMER AND SIGNATURE:

    I hereby affirm that my answers to the foregoing questions are true and correct and that I have not withheld any fact or circumstances that would, if discovered, affect my application unfavorably. I understand that the misrepresentation of omission of a fact called for in this application or any other school records will be cause for immediate dismissal. In addition, I authorize Humanity’s Kitchen to verify any and all information contained in this application. I hereby release Humanity’s Kitchen from any liability whatever that may arise by such disclosure or investigation. I understand further that, should any falsification be discovered, it will constitute cause for non-acceptance or dismissal. I understand that I can make written inquiry, within reasonable time, for a complete and actual disclosure of the contents and scope of the information requested.

    I agree in the event of my training, to complete and abide by all the company’s rules and regulations. Any misrepresentation made in this application will be sufficient cause for cancellation of this application and/or separation of training.

    This application for training shall be considered active for a period of time not to exceed 60 days. At the conclusion of this time, if I have not heard from Humanity’s Kitchen and still wish to be considered for training, it will be necessary to fill out a new application.

    I hereby understand and acknowledge that, unless otherwise defined by applicable law, any training relationship with Humanity’s Kitchen is an “at will” nature, which means that the trainee may resign at any time and Humanity’s Kitchen may discharge trainee at any time with or without cause. It is further understood that this “at will” training relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

    I hereby release Humanity’s Kitchen from any liability resulting from accident or injury occurring as a result of my participation in the culinary training program.

    I understand that if I am accepted into the program, I will not be paid wages for work, but will receive the benefit of culinary training, life skills classes, and job placement assistance.

    I understand that Humanity’s Kitchen has a drug and alcohol policy that provides for random and causal testing before and/or during the program. I consent to and am in compliance with such policy at the time of my enrollment. My continued enrollment is based on the successful passing of testing under such policy.

    If this application leads to enrollment in the program, I understand that I may be asked to take and pass a physical exam, have a TB test done, and/or have a doctor’s release to participate.

    Student Signature:

    Signature of Parent/Guardian if under age of 18

    Humanity’s Kitchen PARTICIPANT WAIVER FORM

    ACKNOWLEDGEMENT

    I expressly acknowledge that there are certain dangers, risks, illnesses and personal injuries inherent in participating in the Humanity’s Kitchen’s programs, events, classes, and/or other activities, which may result from unavoidable accidents or injuries, classes, the use of any equipment, or other activities or from my physical condition. I understand that Humanity’s Kitchen and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns assume no responsibility for loss, damage, illness or injury to person or property that I may sustain as a result of my physical condition or resulting from my participation in any activities, programs, events, classes, the use or non-use of any equipment, field trips, or any other activities, classes, events, or programs at and/or sponsored by Humanity’s Kitchen. I expressly acknowledge, on behalf of myself, heirs and executors, that I voluntarily assume the sole risk for any and all dangers, illnesses and personal injuries that may result from my participation in any events/activities/programs/classes while at Humanity’s Kitchen and/or sponsored by Humanity’s Kitchen.

    I also acknowledge that Humanity’s Kitchen often uses photographs, videotapes, television programs, motion pictures, tape recordings, or other similar media for promotional purposes. I hereby consent to the use of my name(s) and/or likeness(es) in such materials to be exhibited and used for advertising, trade purposes, solicitation of patronage, promotional purposes, or other similar purposes, even if my name(s) and/or likeness(es) are an integral part of such photograph, videotape, television program, motion picture, tape recording, or other similar media. I hereby release Humanity’s Kitchen from any and all claims, actions, and liability relating to its use of said photographs and/or videos.

    RELEASE

    In consideration of Humanity’s Kitchen allowing me to attend and/or participate in any programs, events, classes, or other activities at Humanity’s Kitchen and/or sponsored by Humanity’s Kitchen, I hereby, for myself, heirs, and executors, waive, release and forever discharge Humanity’s Kitchen and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns, from and against any and all rights and claims for any loss, damage, illness or injuries to person or property sustained as a result of my attendance and/or participation in any such programs, events, classes, and other activities, whether or not such loss, damage or injury results from the negligence of Humanity’s Kitchen and its employees, agents, or representatives or from some other cause. My agreement to release Humanity’s Kitchen does not include any loss, damage or injury that results from the Humanity’s Kitchen's gross negligence or willful, wanton, or reckless misconduct.

    I further waive any and all rights to inspect or approve the photograph, videotape, television program, motion picture, tape recording or other use of my name(s) and/or likeness(es), including any written article, script, caption or other writing that may accompany such use of my name(s) and/or likeness(es). I hereby, for myself, heirs, and executors, waive, release and forever discharge Humanity’s Kitchen and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns, from and against any and all liability, claims, losses, costs, expenses or damages for libel, slander, invasion of privacy, conversion, defamation, appropriation of likeness or any other claim based on the use of my name(s) and/or likeness(es) in any such materials.

    INDEMNIFICATION

    I hereby represent and warrant to Humanity’s Kitchen that I have the authority to execute this Participant Waiver Form on behalf of myself. In the event of any misrepresentation or breach of the foregoing warranty by me, or in the event that I, or any other person nevertheless asserts any claim against Humanity’s Kitchen arising out of my participation in any program, event, class or other activity as set forth herein, I agree to indemnify, hold harmless and defend Humanity’s Kitchen from and against any and all liability, claims, losses, costs, expenses or damages resulting therefrom, including, but not limited to, claims of loss, damage, illness or injury to person or property whether or not such loss, damage, illness or injury results from the negligence of Humanity’s Kitchen or from some other cause.

    Student Signature:

    Signature of Parent/Guardian if under age of 18

    UNIFORMS

    SHIRT SIZE
    XSSMLXL2XL3XL4XL5XL

    PANTS SIZE
    XSSMLXL2XL3XL4XL5XL

    GLOVE SIZE:
    SML

    SHOE SIZE

    JPEG, PDF or Word Document only