Job Corps Certificate of Success in Career Achievement N

OMB 1205-0NEW
Expiration Date xx/xx/xxxx
Job Corps Certificate of Success in Career Achievement Nomination Form
Each year, a Job Corps Certificate of Success is awarded to a recent graduate who has achieved a
level of career success as a result of participating in the Job Corps program. Annually
highlighting a recent graduate’s career 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 recent Job Corps graduate for the Job Corps Certificate of Success in Career
Achievement, please timely submit a completed nomination form. If making a nomination,
please confirm that the nominee is willing to be considered for the Certificate of Success and
undergo a background and reference check as a part of the nomination process before
submitting this form.
Self-nominations are permitted.
Nominations for the [Year] award are due by [Date]. E-mail the completed form and photo
to [Certificate of Success e-mail address].
Job Corps Successful Graduate Nomination in Career Achievement
This certificate recognizes a Job Corps graduate who has been out of the program for no more
than 2 years and has successfully begun his/her career path. The graduate’s job position must be
directly linked to his/her Job Corps training, and nominations should include letters of
recommendation from the graduate’s current employer and, if applicable, a former employer.
Since graduation, candidates should have obtained an increase in salary, a promotion, or career
progression.
Graduate Information
Graduate Name:
Job Corps Center Name:
Trade (also referred to as Training Area):
Job Corps Graduation Year:
Current Employer (name and location):
Current Title/Position:
Length of Time in Current Position:
Past Employers, Positions, and Dates of Employment (if applicable):
Candidate Nomination Justification
Review and mark each criterion below and provide supporting details in the space provided.
The nominee graduated from Job Corps and has been out of the program for no more than
2 years. Provide enrollment and completion dates below.

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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
while in Job Corps or prior to entering the program and when the diploma or equivalent
was earned.
The nominee demonstrated commitment to Job Corps through center and/or training area
engagement. Provide details for how the graduate showed this commitment, such as
participation in SGA or dorm leadership, community service, or work-based learning.
The nominee has been employed in the field of his/her Job Corps career technical training
since graduation. Provide details below.
The nominee has obtained employment-related achievements in the area of his/her career
technical training, such as career progression, promotions and/or salary, or other
employment-related awards or recognitions. Provide details below.
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 the graduate’s two most recent employers. Please provide
contact information for follow-up by Job Corps, as needed.
Current employer contact:
 Recommendation:
 Full name, title, company:
 E-mail address and phone number:
Former employer 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.
Nomination Requirements
Please e-mail the completed form and photo to [Certificate of Success e-mail address]. All
nominations must be received by [Date].

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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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