Culinary Job Placement Program at the Mooresville Soup Kitchen is a 12-week program that provides hands on culinary education

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Culinary Job Training Program

Founded in 2018, the Culinary Job Placement Program at the Mooresville Soup Kitchen is a 12-week program that provides hands on culinary education, ServSafe course, job skills coaching and job placement to its diverse students. Scholarships are offered to people from all walks of life. Some recently lost their job, others have been unemployed for quite some time and some apply while currently being employed with low wages and no room for advancement. Many of the students are looking to learn skills to improve their future and are charting a course out of a troubled past to a fresh start in life.

Fundamentals of Food Service Culinary Job Training Program Application

275 South Broad Street, Mooresville, NC 28115 Phone: 704-660-9010 Fax: 704-230-4349

Session Start Date: ______ _____ Date of Application Completion: _________ __ Referral Source: Date of Interview: ______ ____ _ Interviewer: Name: __________________________________DOB: _____________

Email: ______________________________________________________________________________

Address: _______________________________________________________ Phone#: _____________ CITY STATE ZIP Emergency Contact: _________________________________________Phone#: __________________
Education Name Dates Completed Y or N? Degree High School HS grad? Yes / No or GED? Yes / No Vocational or Trade School College Other Special Training
Subjects that you excelled in and/or enjoyed: ____________________________________________ Subjects that you disliked or had difficulties in: ___________________________________________
Work History Please provide information on your current or most recent jobs. (Note: Food service experience is not a requirement for admission to the program.)
Are you currently employed? Yes_____ No______ Please provide info about current or most recent employment below

Employer: ___________________ ______________________________Phone: ___________________ Address: ____________________________________________________________________________ Position: __________________________ Duties: ___________________________________________ Supervisor’s Name: ________________________________________________ Dates of Employment: From: ________ To: _______ full or part time position: FT_____ PT _____
Reason for leaving: ________________________________________________________________ I receive Food & Nutrition Services Yes No Official Use – Copy Provided

A. My household’s gross income is $ yearly monthly weekly Circle One

B. The number in my household is person(s). Put a number in each section below. 18 & under 19-64 65 & Over

Have you ever been terminated from a job for any reason: Yes ___ No ___ If yes, please explain: ____________________________________________________________

Considering your current job or last place of employment, answer the following questions:

What do / did you like best about work: _________________________________________________ What do / did you like least about work: ________________________________________________

Have you ever had a negative experience at work with a supervisor or co-worker: Yes ___ No ____
If yes: please explain ______________________________________________________________
Outcome: ________________________________________________________________________
If no: How would you handle a negative experience at work with a supervisor or co-worker? ________________________________________________________________________________
What skills do you possess with regards to your past and present employment: _________________

Medical / Legal In keeping with our mission, we ask that you disclose the following information so that we can best support you toward success:

Are you living in a transitional home, shelter, or any other social service program? ____________ If yes, what program? ____________________________________________________________
Are you involved in any type of drug or alcohol rehabilitation program? _____________________ If yes, what program? _____________________________ Dates: __________________
Have you ever been convicted of a misdemeanor or felony? Yes_____ No______ If yes, please describe charge(s) and date(s): __________________________________________ _______________________________________________________________________________
Do you have any court cases pending? _______________________________________________
If yes, please describe: ____________________________________________________________
Name and phone # of caseworker/parole officer: ________________________________________
Are you under a doctor’s care?: Yes ____ No _____ If yes, Name:________________________

Are you currently taking any prescription medicine or any other medication? ___________________ If yes, what? _____________________________________________________________________
Do you experience any side effects such as drowsiness, dizziness, impulsiveness, etc.? __________

Do you have any food allergies?: ______ _____ If yes, to what?: _________________________ ________________________________________________________________________________ What happens to you if you eat this food?: ______________________ _____________________

Substance Abuse History Answering yes to any of the following questions does not automatically disqualify you from the program.

Do you currently use drugs other than those required for medical reasons? Yes ____ No _____ If yes which ones? ____________________________________ Have you in the past used drugs other than those required for medical reasons? Yes ____ No _____ If yes which ones? ________________________________ Have you missed work or gotten to work late because of alcohol? Yes ____ No _____ Have you found it difficult to keep a job because of alcohol? Yes ____ No _____ Have you ever been under the influence while on the job? Yes ____ No _____ Do you drink alcohol excessively? Yes ____ No _____

Mental Health

Do you have a mental health diagnosis? : Yes ____ No ____ If so, please list: Do you currently take medication?: Yes ____ No ____ Please list: __________________________ ___ ______________________________________ Are you involved in therapy or counseling?: Yes _____ No _____ How often?

Armed Forces

Are you a veteran of the Armed Forces?: Yes _____ No _____ Branch: _____________ Dates Enlisted: From _______ To ________ Rank: ______________________________ Type of discharge: Honorable _____ Dishonorable ______ Medical ______ Other (please describe): _____________________________________

I verify with my signature that to the best of my knowledge all of the information from pages 1 – 3 is correct and I authorize the MSK staff to confirm the information above (which may include contacting people mentioned in this application).

________________________________________ ____________________ Signature Date
Job Skills Questionnaire

1. What kinds of food do you most like working with? _______________________________ _____________________________________________________________________

2. Which of the equipment in the kitchen are you most comfortable with? _____________________ _________________________________________________________________________________

3. What kinds of kitchen skills do you feel that you are best at? ______________________________ _________________________________________________________________________________

4. What shifts are you willing to work? _________________________________________________ _________________________________________________________________________________

5. Do you work better on your own or with a team? _______________________________________ _________________________________________________________________________________

6. Are you more comfortable working on one project at a time or many projects going on at once? _________________________________________________________________________________

7. What are your goals after graduating from this training program? __________________________ _________________________________________________________________________________

9. What are your strengths? __________________________________________________________ _________________________________________________________________________________

10. What are your weaknesses?_______________________________________________________ _________________________________________________________________________________

11. What would be your ideal job? _____________________________________________________ _________________________________________________________________________________

For Office Use Only _________________________________________________________________________________ ___________________________________________________________________________ _____ _________________________________________________________________________________ _________________________________________________________________________________


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