BreakLine Application 1 Contact Information2 Employment Information3 Video & Essay Submission4 Resume5 Submit Application BreakLine ApplicationThank you for starting an application for BreakLine! You can save your work and return to your application multiple times. Please be sure to click "Save Draft" before navigating away from the application. When you click "Save Draft", you will be given a link that you can use to return to your saved work. Every time you save a draft, you will receive an updated link. If you have trouble accessing the link to your saved application, please email questions@break-line.com and we will send it to you directly.Please select your track.*We work with all participants virtually on an on-going basis.Choose trackBreakLine VeteranBreakLine MavenBreakLine Veteran & MavenIn addition to hands-on education and support, BreakLine also offers programs that provide a behind the scenes look at our partner companies. If you are interested in attending a program, please select your preference below.Choose program (optional)September 24 - 25, 2020October 22 - 23, 2020In addition to hands-on education and support, BreakLine also offers programs that provide a behind the scenes look at our partner companies. If you are interested in attending a program, please select your preference below.Choose program (optional)September 24 - 25, 2020October 22 - 23, 2020Contact InformationFirst Name*Last Name*Email Address* Phone Number*LinkedIn Profile* Street Address*City*State / Province / Region*Zip Code*Country*How did you hear about BreakLine?*Click to select responseReferred by a BreakLine AlumReferred by someone on the BreakLine teamLinkedIn PostFacebook PostInternet SearchSACCTAPBreakLine ClassesOther - Word of MouthOtherHow did you hear about BreakLine?*Click to select responseReferred by a BreakLine AlumReferred by someone on the BreakLine teamLinkedIn PostFacebook PostInternet SearchBreakLine ClassesOther - Word of MouthOtherPlease provide additional context, including any individuals or organizations that referred you. Employment InformationWhat is your earliest start date for full-time employment?* Date Format: MM slash DD slash YYYY What is/was your separation date from the military?* Date Format: MM slash DD slash YYYY How many years of military experience do you have?*How many years of people management experience do you have?*What's the largest team size you managed?How many years of total work experience do you have?*What is the rank you achieved and on what date was it attained?*Have you ever been relieved from duty, dishonorably discharged, or court-martialled?*Click to select responseYesNoIf yes, please explain the circumstances.*Please list all performance report stratifications, awards, and recognitions.*Please list all awards and recognitions.*Please list all completed Professional Military Education, certifications, and professional qualifications.*Do you have an active clearance? If so, please select below.Click to selectTS/SCITS/SCI with CI PolygraphOtherIf other, please provide more detail:Please list all completed certifications and professional qualifications.*Are you considering pursuing higher education (M.B.A., M.A., M.S., Ph.D., etc) in lieu of full-time employment?Click to selectYesNoIf yes, please provide more detail.*What industries are you considering for the next phase of your career?*What are your preferred cities for the next phase of your career?*Are you willing to relocate?*Click to select responseYesNo - other than the city/cities listed aboveAre you actively interviewing? If yes, please provide more detail where possible.* Video Submission and Essay QuestionsVideo SubmissionPlease submit a 2 - 3-minute video in response to the question below. We recommend using your phone or computer and recording yourself in a quiet space. To share the file, please upload the video to Google Drive or Dropbox and paste the link below.Please tell us about yourself and why you are interested in working with BreakLine.*Don't forget to change the settings so that anyone with the link can view the file! Essay QuestionsThe essays are a critical tool to help us get to know you, so please invest time in your answers and be thorough. Please limit responses to 1500 characters (approximately 300 words) per question. When you reflect on your career to date, which achievement matters most to you, and why?When did you fail professionally? What did you learn from it?Please share a forging experience that changed your life and shaped your career path.What are your priorities for the next phase of your career, and where do you see yourself in 5 years? ResumeUpload Resume*Additional Comments (optional) BreakLine admits participants on an equal opportunity basis and values diversity of all kinds.Completing the following form is optional, but we hope you will choose to fill it out. We invite you to voluntarily self-identify your gender below. Female Male Non-binary Other I don't wish to answer We invite you to voluntarily self-identify your race/ethnicity below. American Indian or Alaska Native Asian Black or African American Hispanic or Latinx White or Caucasian Native Hawaiian or Other Pacific Islander Other I don't wish to answer Do you consider yourself a member of the Lesbian, Gay, Bisexual, Transgender and/or Queer (LGBTQ) community? We invite you to voluntarily self-identify below. Yes No No - but I identify as an Ally I don't wish to answer Do you have a disability? We invite you to voluntarily self-identify below. Yes, I have a disability No, I do not have a disability I don't wish to answer You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Blindness, Deafness, Cancer, Diabetes, Epilepsy, Autism, Cerebral palsy, HIV/AIDS, Schizophrenia, Muscular dystrophy, Bipolar disorder, Major depression, Multiple sclerosis (MS), Missing limbs or partially missing limbs, Post-traumatic stress disorder (PTSD), Obsessive compulsive disorder, Impairments requiring the use of a wheelchair, Intellectual disability.Are you a military spouse? We invite you to voluntarily self-identify below. Military Spouse Submit ApplicationHave you previously applied to a BreakLine program?*Click to select responseYesNoIs there anything else you would like us to know that has not been captured elsewhere in the application?Before you submit your application, please read and confirm the following:* I understand and agree that if I am admitted to BreakLine, my name, email, LinkedIn URL, resume, BreakLine profile, and other relevant information will be shared with partner organizations for the purposes of advancing my career.
