BUSINESS SERVICES RECRUITMENT CARD
CONSENT FOR INFORMATION: I hereby give permission for the Baltimore City Mayor's Office of Employment Development to obtain job information from my employer. This may include starting date, current status, hourse and wage data, available medical benefits, and employer satisfaction with my job performance.

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FIRST NAME *
LAST NAME *
PHONE NUMBER *
EMAIL *
ADDRESS *
CITY AND STATE *
ZIPCODE *
LAST FOUR SOCIAL SECURITY # *
DATE OF BIRTH *
GENDER *
RACE *
U.S. CITIZEN *
ALIEN REGISTRATION
EDUCATION STATUS *
ARE YOU A VETERAN? *
DATES OF MILITARY SERVICE (To and From)
ARE YOU REGISTERED AT A CAREER CENTER? *
ARE YOU INTERESTED IN TRAINING PROGRAMS, i.e. CDL-A/B, Pharmacy Tech, etc.? *
DO YOU HAVE A RESUME? *
HAVE YOU BEEN UNEMPLOYED FOR 27 WEEKS OR LONGER? *
CURRENT OR PREVIOUS EMPLOYER *
JOB TITLE *
SALARY PER HOUR *
START DATE *
END DATE *
LENGTH OF EMPLOYMENT *
REASON FOR LEAVING *
HOW DID YOU HEAR ABOUT THIS TRAINING? *
ELECTRONIC SIGNATURE - Type first and last name. *
TODAY'S DATE *
MM
/
DD
/
YYYY
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