Taller San Jose Hope Builders admits students of any race, color, gender identity or expression, religion, disability, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, gender identity or expression, religion, disability, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and other school-administered programs.
*Which program(s) are you interested in?Construction Training Program (Santa Ana)Information Technology (Santa Ana)Medical Clinical Assisting (Anaheim)Registered Behavior TechnicianI need to know more about the programs before I decide
*Who is helping you out with your application? –Please Select– Angie Cinthia Ericka Janet Miguel Sara I am not applying in person Other
*How did you hear about Hope Builders? –Please Select– Saw Advertisement or Social Media Friends, Family or Other Internet Search or Hope Builders Website Community Organization or School Probation/Parole/While Incarcerated/Re-entry Services Event Church Flyer Indeed Other
*If you are applying in person, which location are you applying at? –Please Select– Anaheim Santa Ana I am Applying Online
Please specify referral source (name of Church, Service Provider, etc.) (old)
If through a former Hope Builders student or staff, please list name (old)
*Date of Application
*Name
Alias or Other Names Used
Address Lookup Clear
Address
City
State –Please Select– Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other
County
Zip
No results found
UPDATED Address Lookup Clear
Address
City
State –Please Select– Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other
County
Zip
No results found
*Primary Phone Number ext.
Secondary Phone Number ext.
*Re-enter Primary Phone Number (for validation) ext.
Re-enter Secondary Phone Number (for validation) ext.
*Primary phone number is a:LandlineCell Phone
Secondary phone number is a:LandlineCell Phone
Primary Email
Secondary Email
Re-enter Primary Email (for validation)
Re-enter Secondary Email (for validation)
Instagram User Name
*Social Security Number
This field is required.
*Do you have a current driver license? –Please Select– Yes No
If no, please give reason
California Driver License or California Identification number
Has your driver license ever been revoked or suspended? –Please Select– Yes No
If yes, why?
*Ethnicity –Please Select– Hispanic or Latino Not Hispanic or Latino
*Race (choose all that apply) American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteOther
*Gender –Please Select– Female Male Trans male/Trans man Trans female/Trans woman Gender queer/Gender non-conforming Different identity Prefer not to say
Marital Status –Please Select– Single Married Divorced Domestic Partner Separated Widowed
*Date of Birth
Age at Application
*Do you have health insurance? –Please Select– Yes No
If yes, from which provider: –Please Select– Medi-Cal MSI Employer Other
*Are you currently in school? –Please Select– Yes No
If yes, current school
*What year were you last in school?
*What was the last school you attended?
*Did you graduate high school or obtain the equivalent? –Please Select– Yes, I obtained a High School Diploma Yes, I obtained a GED/High School Equivalency Yes, I obtained a Certificate of Proficiency No, I did not obtain either
If you did not obtain the equivalent, did you obtain a “Certificate of Completion” from your high school? –Please Select– Yes No
What high school(s) did you attend?
Have you attended high school in California for three or more years? –Please Select– Yes No
Have you graduated from a California high school or have attained the equivalent, such as a High School Equivalency, issued by the California State GED Office or a Certificate of Proficiency, resulting from the California High School Proficiency Examination? –Please Select– Yes No
Have you completed more than 20 semester units in college? –Please Select– Yes No
Did you attend special education classes while in high school? –Please Select– Yes No
Were you ever referred to or participated in special education classes?Yes, in elementary schoolYes, in junior high schoolYes, in high schoolNo, I have never been referred to or participated in special education classesI am not sure
Have you ever had an Individualized Education Program (IEP)? –Please Select– Yes No
Please check any of these programs you have completed:Medical AssistingLVNPhlebotomyCNA
Please list any other training you have received:
Please answer the following questions truthfully. Hope Builders values honesty and this will help us serve you better. A criminal record does not automatically disqualify you from the program.
*Have you ever been convicted of a crime? –Please Select– Yes, Misdemeanor Yes, Felony Yes, Both No
If convicted of a crime, what type?BurglaryDomestic AbuseDrug PossessionDUIGang RelatedSexual OffenseTheftVandalismWeapons RelatedNoneOther
Do you have any past or current gang affiliation? –Please Select– Yes, and I am active Yes, but I am no longer active No, I have never had any gang affiliations
Do you have a history of substance abuse? –Please Select– Yes, and I have been clean 0-3 months Yes, and I have been clean 3-6 months Yes, and I have been clean 6-12 months Yes, and I have been clean longer than 12 months I have never had a substance abuse problem
Have you ever been incarcerated/jailed? –Please Select– Yes No
If yes, which county or counties?
Are you currently on probation or parole (informal or formal)? –Please Select– Yes, Probation Yes, Parole Yes, Both No
*Have you been affected by violence? (choose all that apply)Yes, I have been a direct victim of violenceYes, I have witnessed violenceYes, I live in a neighborhood where there is violence (gang activity, robberies, etc.)Yes, I struggle to control my temperNo, I have not been affected by violence
Do you have any other legal problems not addressed above? –Please Select– Yes No
If Yes, what are they?
Do you have right to work documentation? –Please Select– Yes, I have a social security card and a work permit Yes, I have a social security card and a California driver license/identification No, I do not have right to work documentation
Work Permit Expiration Date:
Are you currently employed? –Please Select– Yes, I am employed part time Yes, I am employed full time No, I am not currently employed
If this is a part time job, are you seeking full time employment? –Please Select– Yes No
Most Recent Employment
Skip this section if you have never been employed
Company Name
Job Title
When did you start this position?
Are you still at this position? –Please Select– Yes No
If no, when did you leave this position?
Are you currently receiving employee sponsored health insurance? –Please Select– Yes No
Company Address Clear
Address
City
State –Please Select– Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other
County
Zip
No results found
Duties
Wage
Payment Interval –Please Select– Hourly Weekly Monthly Daily
Reason for leaving job:
What is your family size?
Please estimate your yearly total family income:
Are you a single parent? –Please Select– Yes No
*Are you (or your partner) currently pregnant? –Please Select– Yes No
If yes, what is the expected due date?
*Do you have children? –Please Select– Yes No
If yes, how many?
Do you have children that you financially support? –Please Select– Yes No
If yes, how many do you support?
Have you ever been/or are in foster care? –Please Select– Yes, in the past Yes, currently No
Please choose the language you speak fluently other than English, if any:SpanishVietnameseCambodianOther
Hope Builders is offering online hybrid programs. You will be required to attend virtual classes, complete online assignments and attend in-person classes. Not having access to the following will not automatically disqualify you.
Do you have any of the following? (choose all that apply):Internet/WIFIUnlimited DataSmartphoneAccess to computer/laptopAccess to tablet/iPadDevice with a cameraSpace to attend online classesResources to purchase devices
Notes:
Hope Builders strives to provide supportive services to young adults who have a desire to transform their lives and accomplish their goals.
In the following section, we encourage you to please be honest and indicate what areas you need supportive services/resources.
Please choose the areas you would like support with or assistanceAbusive relationshipAnger problemsCriminal recordExpectant parent/parentingFamily problemsLack close family membersLack foodLack of childcareLack transportationLow self-esteemLegal problemsMental/Emotional health problemsSubstance abuse problems/historyUnable to manage financesUnable to use computerUnstable living situation/HomelessNone Selected
Are your receiving services from any of the following? (choose all that apply)Cal WORKSCal LEARNCare CoordinatorChildren’s Home SocietyDisability AssistanceFood StampsGeneral AssistanceHousing (section 8)Medi-CalTransitional Living FacilityRefugee AssistanceSober Living FacilitySSISSDITANFTherapist/CounselorUnemploymentWIAWICWomen’s ShelterI am not receiving any services.Other
If other, please specify
If you are seeing a therapist/counselor or care coordinator, may we contact them upon getting written consent? –Please Select– Yes No
Therapist/Counselor or Care Coordinator Name
Phone Number ext.
Please provide information of two people to contact in case of an emergency:
Emergency Contact 1
Emergency Contact 1 Phone ext.
Emergency Contact 1 Relationship to you
If we cannot reach you at the contact information entered above, may we contact emergency contact 1?YesNo
Emergency Contact 1 Address Clear
Address
City
State –Please Select– Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other
County
Zip
No results found
Emergency Contact 2
Emergency Contact 2 Phone ext.
Emergency Contact 2 Relationship to you
If we cannot reach you at the contact information entered above, may we contact emergency contact 2?YesNo
Emergency Contact 2 Address Clear
Address
City
State –Please Select– Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other
County
Zip
No results found
In order for your application to be complete, you must provide your:
-Social Security Card and California Driver License/Identification
OR
-Social Security Card and Work Permit
Please note: Social Security card must be signed
You submit these documents by:
-Uploading them to this application
AND
-Bringing them to TSJ Hope Builders at 801 N. Broadway, Santa Ana, CA 92701
If you do not submit these documents within one week, your application will not be considered or moved to the next step in the admissions process.
High School Diploma
Up to 25 MB
California Driver License or California Identification
Up to 25 MB
Social Security card
Up to 25 MB
Work permit
Up to 25 MB
By signing this document, I certify that all information is correct to the best of my knowledge and I acknowledge that such information is subject to verification.
Date
Please type your full name and sign using your mouse.
Name
Signature
Sign
Taller San Jose admits youth of any race, color, nationality and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to youth at the program. It does not discriminate on the basis of race, color, nationality and ethnic origin in administration of its policies.