Virtual Rapid Response Orientation
Contact: Dennis Parks - dennis.parks@lacity.org
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Employee Name: *
Personal Email *
Cell Phone
HOME Address (Include City and ZIP CODE): *
NAME - Company/Employer/Organization that laid you off or will laying you off: *
ADDRESS - Company/Employer/Organization: *
What is/was your Occupation/Title? *
What was your HIRE DATE? *
SELECT the ORIENTATION DATE you are planning to attend. Remember, sessions are only on Wednesdays at 10:00a.m. *
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Employment Status: *
Last day worked or expected to work: *
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Expected date to return to work (if applicable):
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YYYY
Is your job loss/furlough/hour reduction, etc. due to the COVID-19 pandemic? *
How many total people were laid off or will be laid off?  *
Are there any individual needs related to your job loss you want us to help you address or find resources for?
General Comments:
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