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Registration Short Form PDF

Warehouseman Training INC

3150 Mercier Street, KCMO, Suite 534, 64111

Certified Warehouseman & Material Handler

Last  Name: 

First Name: 


Last Four SSN:  

Main Email:  

Alt. Email:      

Address:   Apt #:  

City:   State:   Zip:  

Cell Phone:   Home Phone:  


Gender:  Female    Male    Undisclosed

On Parole/Probation:  Yes    No

Following Questions to determine Sponsor (funding)

Veteran:  Yes    No

Youth (17-24):  Yes    No

Dislocated Worker:  Yes    No

Drug and Alcohol Treatment:  Yes    No

Non-Custodial Parent:  Yes    No

Recieving Food Stamps:  Yes    No

Recieving Unemployment:  Yes    No

Own a Vehicle:  Yes    No

Education:  HS Diploma    GED/HiSet

Have you ever worked with Vocationoal Rehab (VR):  Yes    No

How did you hear about Us