Work Placement Program Registration

Personal Information

First Name *

Last Name *

Date of Birth *

RMI Social Security Number *

Current Residence

Graduation Year

From your latest educational institution

Gender

Male Female

Citizenship

RMI Other

Citizenship (please specify)

Are you disabled?

Yes No

Do you have any prior work experience?

Yes No

Highest Level of Education

Elementary School Middle School High School CMI GED/ABE course Associate degree Bachelor's degree Master's degree

What was the focus / major / topic of your studies?

e.g. accounting, welding

Contact Information

Email *

Telephone / Cell Number *

Program Details

Apply Location *

Majuro Ebeye, Kwajalein

Application Type *

New Extension

What is your training interest / preferences?

Preferred Placement Duration

6 months 12 months

Availability to Start Placement

Location of where you wish to do your work placement

Reasons for Applying to the Work Placement Program

List any relevant skills and qualifications not already mentioned

e.g. language proficiency, software proficiency, certifications

Are you familiar with any specific software or tools related to your preferred placement area?

Yes No

Do you have any volunteer or internship experience related to your field of preference?

Yes No

I hereby declare that all information provided in this application is true and accurate to the best of my knowledge. I understand that providing false or misleading information may result in disqualification from the Work Placement Program. *

Yes No

Supporting Documents

Optional — you can also bring these in person or send them later. PDF, Word, Excel, or image files up to 10MB each.

Name of Employer

Request letter

Training Plan

Resume

Diploma/Certificate/Degree

RMI Social Security

Signature *

Upload Signature