This screening assessment is used to review your eligibility for the WIOA Adult and Dislocated Worker Program. Please complete all of the required questions and a Career Coach 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 are between the ages of 18-24, DO NOT proceed. Please visit the webpage for WIOA Youth  located below and apply through the Youth Program.
https://www.careersourcetampabay.com/job-seekers/youth/

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* 1. Were you economically injured as a result of the COVID-19 pandemic?

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* 2. Were you laid off as a result of the COVID-19 pandemic?

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* 3. Are you unemployed as a result of the COVID-19 pandemic?

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* 4. Are you interested in a training program that is less than 4 Months?

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* 5. First Name:

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* 6. Middle initial:

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* 7. Last Name:

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* 8. Full Social Security Number:

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* 9. Date of Birth:

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* 10. Physical Address:

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* 11. City:

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* 12. State:

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* 13. Zip code:

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* 14. County of Residence:

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* 15. Personal Email:

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* 16. Phone Number:

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* 17. Alternative Phone Number:

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* 18. Have you registered in EmployFlorida.com?

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

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

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

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

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* 23. Are you currently working?

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* 24. Current rate of pay?

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* 25. Hours worked per week?

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

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

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* 28. Are you receiving Unemployment, or have you exhausted your unemployment benefits?

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

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

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

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

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* 33. Specify year and location of conviction:

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

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

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* 36. 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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* 37. 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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* 38. Type of income? (Please select all that apply)

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* 39. Highest Education Level?

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* 40. List degrees/licenses/certifications that you’ve earned. Specify the year that you received each.

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* 41. Are you interested in tuition assistance to return to school?

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* 42. If yes to question # 41 , have you selected a school that is on the CareerSource Tampa Bay Approved Training Provider List? Eligible training provider list is located at https://www.careersourcetampabay.com/wp-content/uploads/2020/07/CSTB-Approved-Training-Programs-PY-2020-21_07.31.2020-Customer.pdf

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* 43. If yes to question #42, what is the name of the training provider?

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* 44. What is the name of the training program?

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* 45. If you are not interested in school, what type of employment are you seeking?

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* 46. What type of position are you seeking? i.e. Customer Service, Electrician, Construction, Etc.) Specify one:

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* 47. Did you hear of a specific OJT opportunity that you are interested in?

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* 48. Please list the specific OJT opportunity:

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* 49. Do you use Tobacco products, such as Cigarettes, cigars, or chewable tobacco?

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* 50. If Yes, would you like information on free products and support to help you quit smoking?

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