5-Day Job Seeker Basic Training Interest Form

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. Please fill out the information below:

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 4. What is the best way to contact you?

E-mails

Phone Calls

Text Messages

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* 5. What are the best days and times to contact you?

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* 6. What is your English proficiency?

No English

A Little English

Conversational English

Fluent English

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* 7. What other languages do you speak?

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* 8. What city do you live in?

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* 9. What type of transportation do you have?

No Transportation

Public Transportation (Bus or Light Rail)

Personal Vehicle

Other (please specify)

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* 10. Do you have access to a laptop that you can bring to class every day?

Yes

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* 11. What type of job are you looking for? Check all that apply.

Caring for sick people

Working with your hands

Working in a store

Working in food service

Using technology

Manufacturing

Agriculture/Farming

Construction

Outdoor work

Office/Desk Job

Customer Service

Sales

Professional Jobs (Accounting, Engineering, IT, Marketing, Linguistics, etc.)

Other (please specify)

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* 12. Which program dates work better for you?

July 16th through July 21st (confirmed dates)

July 23rd through July 28th (tentative dates)

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* 13. Are you willing to wear a mask during the training program to help prevent the spread of COVID-19?

Yes

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* 14. Do you have a case manager?

Yes