WorkLink: Online Application Form

East Pittsburgh-Swissvale Route

Clairton Route

Clairton-McKeesport-Glassport-Waterfront Route

Online Application Form

All information you provide on this application will remain confidential. The rider ID card will be used for identification, and to collect entry/exit data so we can monitor WorkLink's usage and effectiveness.

The form must be completed for service to be authorized. When you're finished, click the "Submit" button.

PERSONAL

Today's date	/ /
Last name		First name
Address
City		, PA	Zip Code	Phone
DOB (MM/DD/YY)	/ /	Gender
Neighborhood

EMPLOYMENT

Currently employed

Yes No

Employed last 6 months

Yes No

Employment status

Full Part-time

Name of employer #1

Name of employer #2

Enrolled in job training-school? Yes No Location?
How do you handle child care?	Home Center Relative Friend Other
Location of child care

EDUCATION

Are you currently in school?	Yes No	If yes, where?
If no, enter last school attended		Highest grade completed
Technical / vocational certification?	Yes No

TRANSPORTATION

Have access to a car?	Yes No	Have a valid PA drivers license?	Yes No
Easy access to public transportation?	Yes No
Need special transportation assistance?	Yes No	Disabled

Primary reason for using WorkLink

Work Job training Education Child care Health care Shopping Leisure
Other

Port Authority routes used & purpose of trip

Rt #
Work Job training Education Child care Health care Shopping Leisure
Other

HOUSEHOLD

Head of household?	Yes No	Live with parent-guardian?	Yes No
Married	Yes No

Children 11 and under

Last name		First name		DOB (MM/DD/YY)	/ /
Last name		First name		DOB (MM/DD/YY)	/ /

Children 12-17

Last name		First name		DOB (MM/DD/YY)	/ /
Last name		First name		DOB (MM/DD/YY)	/ /