First Name *

Last Name *

Address One *

City *

State *

Zip *

Email *

Phone *

Date of Birth *

National Origin * AfricanAmericanAsianCentral and Latin AmericanEuropeanMiddle EasternNorth American (excluding USA)OceaniaTwo or moreOther

Race * AsianBlack/African AmericanHawaiian/Pacific IslanderHispanic/LatinoNative American/American IndianWhiteTwo or more racesOther

Sex * MaleFemaleOther

Are you a former or current member of the military or a military spouse? * YesNo

Please select your highest level of education obtained * Some High School Or Less High School Diploma/GED/Equivalent Some College Associate's Degree Bachelor's Degree Advanced Degree (Master's) PhD Other

Please select the best description of your current employment status * Employed full-timeEmployed part-timeUnemployed and seeking employmentFull-Time Student

Are you currently enrolled in an educational or training program? * YesNo

Are you available for training from January 5, 2026 – January 30, 2026? * YesNo

Are you able to attend in-person classes at Frederick Community College? * YesNo

Are you interested in the AM or PM training class? * 9:00 AM - 1:00 PM5:00 PM - 9:00 PMNo preference, I can do either

Do you currently have reliable transportation to get you to and from training/work? * YesNo

Are you seeking full-time employment starting February 2026 (upon completion of the Boot Camp)? * YesNo

What is your current U.S. work authorization status? * U.S. citizenU.S. permanent resident (Green Card holder)Work authorized (e.g., Employment Authorization Document)Not currently authorized to work in the U.S.Prefer not to answer

Please rate your ability to work non-traditional hours (shifts may include hours different from 9-5)? * 1 - I require a standard weekday schedule only.2 - I could occasionally adjust my schedule if needed3 - I have flexibility depending on the job requirements.4 - I’m comfortable with non-traditional hours or shifts.5 - I actively prefer non-traditional or flexible hours.

How would you rate your prior laboratory experience? * 1 – No prior experience2 – Limited experience (I’ve had minimal exposure, such as classroom labs)3 – Moderate experience (I’ve completed some hands-on lab work or training)4 – Strong experience (I’ve worked in a lab environment regularly)5 – Extensive experience (I have advanced or professional lab experience)

What is your salary requirements for an entry-level position in the bio-industry? * $15 - $20 per hour$20 - $25 per hour$25 - $30 per hour> $30+ per hour

Please provide your motivation in applying for the Biotech Boot Camp. *

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