Get There Faster Prescreen Survey Question Title * 1. First Name Question Title * 2. Middle Initial Question Title * 3. Last Name Question Title * 4. Full SSN Question Title * 5. Date of Birth Question Title * 6. Physical Address Question Title * 7. City Question Title * 8. State Question Title * 9. Zip Code Question Title * 10. County of Residence Question Title * 11. Personal Email Question Title * 12. Phone Number Question Title * 13. Alternative Phone Number Question Title * 14. How did you hear about the Get There Faster Grant? CSTB Staff Referral Friend/Family Member Bus CSTB Website Google or other search engine Job Fair Other (please specify) Question Title * 15. Have you registered in EmployFlorida.com? Yes No Question Title * 16. What is the highest education level that you have attained? HS Diploma GED Occupation or Industry Certification BS or BA MS or MA Question Title * 17. Are you a US Citizen or legally authorized to work in the U.S.? Yes No Question Title * 18. All males born January 1, 1960, or later are required to selective service register. Are you registered for Selective Service? To check your registration, please visit sss.gov Yes No N/A Question Title * 19. Do you consider yourself to have a disability? Yes No Question Title * 20. Are you a veteran who has been terminated/laid off? Yes No Question Title * 21. Are you a veteran who was formerly self employed but is unemployed due to local economic conditions? Yes No Question Title * 22. Are you a previous member of the Armed Forces whose discharge status is other than “dishonorable”? Yes No Question Title * 23. Are you a separating or transitioning service member who has received an approved separation date? Yes No Question Title * 24. If applicable, what is your approved separation date? (Date format: MM/DD/YYYY) Question Title * 25. Are you the spouse of an active duty service member and have been forced to leave your job due to a change in duty? (applies to service members on active orders) Yes No Question Title * 26. Are you a spouse of an active duty member of the Armed Forces and your income has been significantly reduced due to change in duty station? (applies to service members on active orders) Yes No Question Title * 27. Are you the spouse of a Disabled Veteran who has passed away due to a Service Connected Condition? Yes No Question Title * 28. Are you currently working? Yes No Question Title * 29. If currently working, what's your current rate of pay? Question Title * 30. Are you able and willing to work full time? Yes No Question Title * 31. Have you received a notice of termination or layoff from your job? Yes No Question Title * 32. Have you applied for unemployment benefits? Yes No Question Title * 33. Are you receiving unemployment benefits, or have you exhausted your unemployment benefits? Yes No Question Title * 34. Have you been convicted of a felony or misdemeanor? Yes No Question Title * 35. If applicable, specify year and location of conviction: Question Title * 36. Are you currently receiving or have received SNAP/Food Stamps assistance in the last six months? Yes No Question Title * 37. Are you currently receiving TANF/Cash assistance through DCF? Yes No Question Title * 38. What is your immediate family size? Note: this includes all members in your household related by blood, marriage or court decree. Question Title * 39. What is your total annualized household income before taxes? Family income = all individuals in your household related by blood, marriage or court decree Question Title * 40. What profession are you interested in? Done