Workforce Project Policies

Disclaimer: The information you provide on this form will remain confidential and will only be used to improve services aimed at workforce development activities.

Please Print: Last Name: ________

First Name

Middle Initial

_/

/

SSN:

Date of Birth:

Year

Month Day

Ethnicity:

Would you describe yourself as Hispanic or Latino?

Yes (1) No (2)

Race:

Would you describe yourself as:

Asian African American American Indian/Alaskan native

Hawaiian native/ Pacific Islander White

Sex:

Male (1)

Female (2)

Level of Education:

Employment Status:

Please indicate which of the following best

Please indicate if you are currently:

describes your level of education :

Less than High School (1) High School degree/GED (2) Some college (no degree) (3) Associate degree (4) Bachelor degree (5) Graduate/Professional degree (6)

Employed (1) Retired (2) Unemployed (3)

Employment Type:

Temporary employment:

Please tell us if your current or most recent

Please indicate if your current or most recent

employment is/was:

employment is/was temporary:

Full Time (1) Part Time (2) Seasonal (3)

Yes (1) No (2)

Please name your current or most recent employer:

( Your) Address :

Street

City

State Zip

County

Signature:

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