This questionnaire is designed to help us provide a program to meet your personal career and training needs associated with your layoff. You are not required to provide personal information, but the completion of this survey will allow us to best assist you. Individual responses are confidential.

Rapid Response/Virginia Workforce Network is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities.

* Job Title:

* Who is or was your last employer?

* Type of Employment?

* What type of job are you or will you be seeking?

* Please indicate the area(s) of your career interests.

* Please indicate the highest level of education that you have completed.

* Do you believe additional education or training would make you more employable? If yes, please indicate the type(s) of education and training that would be beneficial.

* What type of workshops would you attend if offered at a convenient location? Check all that are of interest to you.

* Indicate any other assistance or services you would be interested in receiving.

* Your Information
Responses are confidential. Questions are asked to help match you with programs available for you.

* Notes that you would like to share:

The Rapid Response team is a partnership of agencies and organizations that assist employees who are experiencing job loss due to layoff. Thank you for completing this assessment that will allow us to assist with your future employment goals.