Job Corps Hall of Fame Candidate Nomination Form

OMB 1205-0NEW
Expiration Date xx/xx/xxxx
Job Corps Hall of Fame Candidate Nomination Form
Each year, the Job Corps Hall of Fame recognizes a graduate who has achieved a high level of
educational or career success as a result of participating in the Job Corps program. Annually
highlighting a graduate’s success story, especially a graduate who epitomizes long-term career
success and considers Job Corps to be the foundation for these achievements, is vital to
demonstrating the program’s role in creating the workforce of today and tomorrow, and future
influencers and community leaders.
To nominate a Job Corps graduate for the Job Corps Hall of Fame, please timely submit a
completed nomination form. Self-nominations are permitted.
If making a nomination, please confirm that the nominee is willing to be considered for the
Hall of Fame and undergo a background and reference check as a part of the nomination
process before submitting this form.
Nominations for the [Year] are due by [Date]. E-mail the completed form and photo to [Hall
of Fame e-mail address].
Graduate Information
Graduate Name:
Job Corps Center Name:
Trade (also referred to as Training Area):
Job Corps Graduation Year:
Current Employer (name and location):
Attainment or Participation in One or More of the Below after Graduating from Job Corps
(Check “Y” or “N”):
 Higher Education: ___Y ___N
 Apprenticeship (if applicable): ___Y ___N
 Military: ___Y ___N
Candidate Nomination Justification
Review and mark each criterion below and provide supporting details in the space provided.
The nominee graduated from Job Corps after having participated for at least 8 months
and has been out of the program for at least 5 years. Provide enrollment and completion
dates below.
The nominee completed at least one Job Corps career technical training program and has
a high school diploma or its equivalent. Provide the name of the trade/training and when
it was completed; explain whether the high school diploma or its equivalent was earned

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while in Job Corps or prior to entering the program and when the diploma or equivalent
was earned.
The nominee is employed in the field of his/her Job Corps career technical training.
Provide details below.
The nominee has obtained employment-related achievements in the area of his/her career
technical training, such as career progression, rapidity and level of promotions and/or
salary, or other employment-related awards or recognitions. Provide details below.
The nominee has obtained additional educational achievements, such as diplomas,
degrees, and awards after graduating from the Job Corps program. Please specify.
The nominee has made a contribution to his/her community through community service,
including mentorships and volunteerism. Provide details below.
The nominee has agreed to an additional vetting process that includes submitting
professional licenses or affiliations, two recommendations from professional and personal
contacts, and a criminal background check.
Success Story
Provide a brief narrative (not to exceed three paragraphs) sharing the graduate’s personal success
story and how Job Corps changed his/her life. A quote from the graduate about his/her Job
Corps experience as it relates to career success is welcome.
Recommendations
Provide a brief recommendation from two people who can speak to the graduate’s professional
challenges and accomplishments after Job Corps. Unless the graduate is self-employed, it is
strongly recommended that one of these people be the graduate’s employer. Provide contact
information for each referral for follow-up by Job Corps, as needed.
Primary contact (highly recommended to come from the graduate’s employer):
 Recommendation:
 Full name, title, company:
 E-mail address and phone number:
Secondary contact:
 Recommendation:
 Full name, title, company:
 E-mail address and phone number:
Photo
Please provide a high-resolution photo of the graduate in professional attire with this nomination.
Feel free to submit additional photos, such as those showing the graduate while enrolled in Job
Corps or highlights from his/her career or community work.
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Nomination Requirements
Please e-mail the completed form and photo to [Hall of Fame e-mail address]. All nominations
must be received by [Date].

Public Burden Statement - Persons are not required to respond to this collection of information
unless it displays a currently valid OMB control number and expiration date. Public reporting
burden for this collection of information, which is required to obtain or retain benefits (29 USC
2881), is estimated to average 60 minutes per response for Job Corps staff and 120 minutes for
graduate self-nomination including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and the completing and reviewing the
collection of information. This information collection is for program management and
Congressional reporting purposes. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to the
U.S. Department of Labor, Office of Job Corps. Room N-4507, Washington, D.C. 20210
(Paperwork Reduction Project 1205-0NEW).

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