Job Seeker Input Form
Please complete this short form. We use this information to get in touch with you and to assign a mentor to you, if requested. All information is confidential.
Job/Career Interest Areas
Have you been a part of our program in the past?
If Yes, did you did you have a mentor? Who was it?
Please tell us a little more about your situation
How long have you been looking for a job ?
Less than 6 months
Greater than 2 years
Highest Level of Education
Trade, community college, or other associate degree (2 year)
Undergraduate college (4 year)
Graduate education (Master's or PhD)
Prefer not to say
How did you find out about us?
Referred by a past participant
Referred by a friend, mentor, or colleague
Referred by another church
Referred by WorkSource or other employment group or agency
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This form was created inside of Job Seekers.