WIOA Youth Pre-Screen

This screening assessment is used to review your eligibility for the WIOA Youth Program. Please complete all of the required questions and a Career Counselor will reach out to you with next steps within 48 hours. If you experience difficulty completing this assessment, you may come to an informational session for assistance. These are at the CareerSource Tampa Bay office located at 9215 N. Florida Avenue, Tampa, FL 33612 on Mondays, Wednesdays, and Fridays at 10:00am and 2:00pm.

For more details about this program please visit our website at http://careersourcetampabay.com/pages/wioa_youth_training.

If you are not between the ages of 18-24 or reside outside of Hillsborough County, DO NOT proceed. Please visit the webpage for WIOA Adult/Dislocated Worker located below.
http://careersourcetampabay.com/pages/wioa

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Date of Birth (month/date/year)

Date

Question Title

* 4. Full Social Security number (xxx-xx-xxxx)

Question Title

* 5. Primary Telephone Number

Question Title

* 6. Secondary Telephone Number 

Question Title

* 7. Email Address

Question Title

* 8. Preferred Method of Contact

Question Title

* 9. Current Residential Address (city/state/zip)

Question Title

* 10. County of Residence

Question Title

* 11. Gender

Question Title

* 12. Are you a US Citizen?

Question Title

* 13. If you answered no to question 10, what is your current status?

Question Title

* 14. What is your highest level of education?

Question Title

* 15. List degrees/licenses/certifcations that you have earned. Specify the year that you received each. (Put N/A if you haven't received any)

Question Title

* 16. Are you employed?

Question Title

* 17. If you answered yes to question 16, please specify your employer, rate of pay, and start date

Question Title

* 18. What is your annualized family income?

Question Title

* 19. Do you or a family member currently receive Temporary Assistance for Needy Families (TANF)?

Question Title

* 20. Do you or a family member currently receive Supplemental Security Income (SSI)?

Question Title

* 21. Do you or a family member currently receive Food Stamps (SNAP) or have received Food Stamps (SNAP) during the previous six months?

Question Title

* 22. Have you ever been arrested or convicted of a crime?

Question Title

* 23. Are you pregnant or have a dependent child?

Question Title

* 24. Are you a youth who is currently in foster care or had aged out of foster care?

Question Title

* 25. Do you have a disability?

Question Title

* 26. Do you currently reside in a homeless shelter or are you currently homeless?

Question Title

* 27. Have you reviewed our approved training vendors and targeted occupations list?

Question Title

* 28. What is your program of interest?

Question Title

* 29. If you are interested in post secondary education, what is your desired training program?

Question Title

* 30. If you are interested in post secondary education, what is your desired school for training?

Question Title

* 31. Did you relocate to Florida from Puerto Rico or the Virgin Islands as a result of Hurricane Maria after September 17, 2017?

T