The following screening assessment is used to review your eligibility and suitability for the WIOA Adult and Dislocated Worker Program through CareerSource Tampa Bay (CSTB). On-the-Job Training (OJT) will be funded thru Workforce Innovation Opportunity Act (WIOA) funding.  Please complete all of the required questions and a CSTB Recruiter will reach out to you with next steps within 48 hours. If you experience difficulty completing this assessment, you may visit one of our Career Center locations and seek assistance.

For more details about this program please visit our website at https://www.careersourcetampabay.com/job-seekers/wioa/


If you fall between the ages of 18-24, other Youth services such as Paid Work Experience or services for a young adult may be available to you. Please visit the webpage for WIOA Youth located below to seek more information on the CSTB Youth Programs.
https://www.careersourcetampabay.com/job-seekers/youth/

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* 1. First Name:

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* 2. Middle initial:

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* 3. Last Name:

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* 4. Full Social Security Number:

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* 5. Date of Birth:

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* 6. Physical Address:

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* 7. City:

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* 8. State:

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* 9. Zip code:

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* 10. County of Residence:

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* 11. Personal Email:

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* 12. Phone Number:

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* 13. Alternative Phone Number:

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* 14. Have you registered in EmployFlorida.com?

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* 15. Are you a U.S. Citizen or legally authorized to work in the U.S.?

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* 16. All males born January 1, 1960 or later are required to register with Selective Service. If applicable, have you completed this registration? To check your registration please visit sss.gov.

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* 17. Do you consider yourself to have a disability?

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* 18. Are you in the military, an eligible veteran, or spouse of an eligible veteran?

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* 19. Are you currently working?

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* 20. Current rate of pay?

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* 21. How many hours do you work per week?

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* 22. Are you able to work full-time?

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* 23. Have you received a notice of termination or layoff from your job?

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* 24. Are you receiving Re-employment Assistance formerly called Unemployment or have you exhausted your Re-employment Benefits formerly called Unemployment Compensation or UC?

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* 25. Are you a current Active Duty Military Spouse who is unemployed/underemployed?

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* 26. Are you a displaced homemaker? (Lost financial support of a spouse or family member due to divorce or death.)

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* 27. Self-employed: Did you close your business due to the economy or natural disaster?

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* 28. Have you been convicted of a felony or misdemeanor?

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* 29. Specify year and location of conviction:

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* 30. Are you currently receiving or have received SNAP/Food Stamps assistance in the last six months?

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* 31. Are you currently receiving TANF/Cash assistance?

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* 32. What is your family size? (This includes the total number of people in your family= all individuals in your household related by blood, marriage or court decree.)

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* 33. What is your total annualized household income before taxes? (Family income = all those living in a household related by blood, marriage or court decree.)

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* 34. Type of income? (Please select all that apply)

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* 35. Highest Education Level?

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* 36. Are you seeking full-time employment?

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* 37. Do you use tobacco products, such as cigarettes, cigars, or chewable tobacco?

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* 38. If yes to question 37, would you like information on free products and support to help you quit smoking?

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* 39. Were you referred by an employer to the CSTB WIOA OJT program?

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* 40. Which employer referred you to the OJT program?

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* 41. Have you started work or been given a start date by the employer?

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* 42. Please enter start date and job position

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