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 is an equal opportunity program. 

Name of company which layoff occurred. 

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* Name of company which layoff occurred. 

Name

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* Name

Address

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* Address

City/County of Residence

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* City/County of Residence

Phone #

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* Phone #

Age

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* Age

Email

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* Email

If "no", what is your primary language?

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* If "no", what is your primary language?

Job Title:

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* Job Title:

Other Jobs Held, with this employer or others?

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* Other Jobs Held, with this employer or others?

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

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

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

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

Highest level of education you've completed.

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* Highest level of education you've completed.

Please list number of years of college/technical school and type of training or degree:

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* Please list number of years of college/technical school and type of training or degree:

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

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

Description of Certification, Licensure, or Vocational Training

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* Description of Certification, Licensure, or Vocational Training

What type of workshops would you attend if offered at a convenient location?

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* What type of workshops would you attend if offered at a convenient location?

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

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

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.
 

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