IDENTIFICATION One (1) Item from List A OR Provide verification for the following One (1) Item from List B identification: AND One (1) Item from List C List B List A State issued Driver’s License or State I.D.  Card w/Picture or Information (Name, Sex, Date of Birth, Height, Weight & United States Passport  Color of Eyes) Certificate of United States Citizenship  U.S. Military I.D. Card AND  Certificate of Naturalization  Unexpired Foreign Passport w/Attached List C  Employment Authorization Original Social Security to be Witnessed  Alien Registration Card w/Photograph at Intake  Certificate Issued by State, County  or Municipal Authority Unexpired INS Employment Authorization  What is your highest level of education? Check one: formal schooling No elementary school (grades 1-8) Some high school (grades 9-12) but no high school diploma Some education certificate of completion/attendance Special school diploma High (high school equivalency certificate) GED Name of High School college/vo-tech No degree – Some Present Certificate Vocational/Technical Degree Associate Degree Bachelor’s Degree or Higher Master’s College/Vo-Tech Schools : Name of School: Address of School : How can the Bureau be of assistance to you? What employment related services are you seeking: Are you working? If yes, where: If no, check one: Student Student H.S. Other Trainee/Intern/Volunteer Employed Other Not If you are employed, how many hours do you usually work per week? If you are employed, what are your current WEEKLY earnings? $ (gross wages, salaries, tips or commissions before payroll or tax deductions)
IDENTIFICATION One (1) Item from List A OR One (1) Item from List B AND One (1) Item from List C Provide verification for the following identification: List A  United States Passport  Certificate of United States Citizenship  Certificate of Naturalization  Unexpired Foreign Passport w/Attached Employment Authorization  Alien Registration Card w/Photograph List B  State issued Driver’s License or State I.D. Card w/Picture or Information (Name, Sex, Date of Birth, Height, Weight & Color of Eyes)  U.S. Military I.D. Card AND List C  Original Social Security to be Witnessed at Intake  Certificate Issued by State, County or Municipal Authority  Unexpired INS Employment Authorization What is your highest level of education? Check one: No formal schooling Some elementary school (grades 1-8) Some high school (grades 9-12) but no high school diploma Special education certificate of completion/attendance High school diploma GED (high school equivalency certificate) Name of High School Some college/vo-tech – No degree Present Vocational/Technical Certificate Associate Degree Bachelor’s Degree Master’s Degree or Higher College/Vo-Tech Schools : Name of School: Address of School : How can the Bureau be of assistance to you? What employment related services are you seeking: Are you working? If yes, where: If no, check one: H.S. Student Other Student Trainee/Intern/Volunteer Other Not Employed If you are employed, how many hours do you usually work per week? If you are employed, what are your current WEEKLY earnings? $ (gross wages, salaries, tips or commissions before payroll or tax deductions)
BVR_App_Large_Print.docx