First Name / Primer nombre
Last Name / Apellido
Phone / Número de teléfono
Email / Correo electrónico
Home Zip Code / Código postal
Family Member Enrollment
Available for one eligible family member of an Assistant Manager, Restaurant Manager, Salaried Manager/Chef, Above Restaurant Leader or RSC TM / Ahora disponible para un familiar elegible de un Subdirector, gerente de restaurante, gerente/chef asalariado, líder de restaurante superior o RSC TM
Are you enrolling a family member?
Yes - For family member
No - For myself
Gender / Género
Please select...
Female
Male
Prefer not to answer
Marital status? / Estado civil
Please select...
Single
Married
Prefer not to answer
Do you have children? / ¿Tiene hijos?
Yes
No
Employee ID / Número de identificación del empleado
Job title / Trabajo
Where do you work? / ¿Donde trabajas?
Please select...
Brinker
Chili's
Maggiano's
State / Estado
Pathway of interest / Camino de interés
Please select...
Basic Skills
Citizenship Prep
Civics
Certificate
Debt-Free Associates Degree
ESL: English as a second Language
GED: High School Equivalency
Learn Spanish
Tuition Reimbursement
Program of interest / Programa de Interés
Please select...
AA: Early Childhood Education
AA: Elementary Education
AA: English Concentration
AA: General Concentration
AA: History Concentration
AA: Hotel & Restaurant Management
AAS: Business
AAS: Early Childhood Studies
AAS: Health Information Technology
AAS: Hospitality Leadership
AAS: Logistics and Supply Chain
ABUS: Business Administration Transfer
Program of interest / Programa de Interés
Please select...
CERT: Advanced Business
CERT: Advanced Culinary Arts
CERT: Basic Business
CERT: Baking & Pastry Arts
CERT: Basic Logistics and Supply Chain
CERT: Bookkeeping
CERT: Child Development Associate (CDA)
CERT: Culinary Fundamentals
CERT: Early Childhood Assistant
CERT: Elementary Education
CERT: Health Information Technology
CERT: Human Resources
CERT: IT Support Technician
CERT: Medical Billing & Coding
CERT: Secondary Education
CERT: Special Education
CERT: Special Education for Teachers
CERT: Hotel and Restaurant Management
What College Degree Program do you plan to pursue? / ¿Qué programa de título universitario planeas seguir?
Highest level of education / Mayor Nivel de Educación Completado
Please select...
No high school diploma
High school diploma
Some community college
Associate's Degree
Bachelor’s Degree
Master's degree
Other
What year did you graduate high school? / En que año te graduaste de la escuela secundaria
What is motivating you to explore skill development options at this time? / ¿Qué lo motiva a explorar opciones de desarrollo de habilidades en este momento?
Please explain details of your goals and why you are motivated in developing your skills / Explique los detalles de sus objetivos y por qué está motivado para desarrollar sus habilidades.
NEW! Family Member Enrollment
Now available for one eligible family member of a CSL Assistant Manager, Restaurant Manager, Salaried Manager/Chef, Above Restaurant Leader or RSC TM / Ahora disponible para un familiar elegible de un CSL Subdirector, gerente de restaurante, gerente/chef asalariado, líder de restaurante superior o RSC TM
Are you adding a family member as part of your enrollment? / ¿Está agregando un miembro de la familia parte de su inscripción?
Yes
No
Family Member Name / Nombre del dependiente
Family Member Age / Edad del dependiente
How is the family member related to you? / ¿Cual es el parientesco del miembro de la familia con usted?
Please select...
Legal Spouse
Domestic Partner
Child
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