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Virtual Rapid Response Orientation
Contact: Dennis Parks -
dennis.parks@lacity.org
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* Indicates required question
Employee Name:
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Your answer
Personal Email
*
Your answer
Cell Phone
Your answer
HOME Address (Include City and ZIP CODE):
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Your answer
NAME - Company/Employer/Organization that laid you off or will laying you off:
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Your answer
ADDRESS - Company/Employer/Organization:
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Your answer
What is/was your Occupation/Title?
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Your answer
What was your HIRE DATE?
*
Your answer
SELECT the ORIENTATION DATE you are planning to attend. Remember, sessions are only on Wednesdays at 10:00a.m.
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MM
/
DD
/
YYYY
Employment Status:
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Laid off (permanent)
Laid Off (temporarily)
Hours Reduction / Furlough
Other - specify in the General Comments below . . .
Last day worked or expected to work:
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MM
/
DD
/
YYYY
Expected date to return to work (if applicable):
MM
/
DD
/
YYYY
Is your job loss/furlough/hour reduction, etc. due to the COVID-19 pandemic?
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Yes
No
How many total people were laid off or will be laid off?
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Your answer
Are there any individual needs related to your job loss you want us to help you address or find resources for?
Your answer
General Comments:
Your answer
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