Open a Case

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Open a Case

Completing this information will help me fill out job applications for you. If you have any questions, please contact Heath at facebook.com/heathray , hray@casoky.org , 270-783-4484 ex1017

Hello!! Jambo!! If you have not met me before, my name is Heath and I am here to help you plan your future! I work in Bowling Green at Community Action and we can do many things over the internet or phone. By giving me more details about yourself, I will be better able to help you with what you are looking for. Please answer these short questions below.

Name *

First & Last Name

Name on Facebook

Heath will update you on messenger if you are on Facebook.

Phone number *

Address *

Include street, apartment, zip code

What is your date of birth? *

YYYY

How many years have you lived in the United States? *

You must have lived in the US for less than 5 years to participate in employment services.

How did you find this link today? *

Heath or Florence gave it to me

A friend shared it with me

Workforce Development shared it with me (Brian or the Job Seeker Map)

By searching the internet

Other:

How can I help you? *

There are many ways I can help. Choose as many as you would like. If there is something not listed, please use the "other" option to explain.

These services are available only to refugees who have lived in the US for less than 5 years.

To find a job quickly (Tyson, Walmart, Trace, Taco Bell, etc)

I don't know what career I want to do in the future, and would like help learning about options. (example: Do I want to be a nurse? How much money do nurses make? How much education do nurses need?)

I already know what career I want to do, but need help PLANNING how I will do it (example: How to be a nurse)

I would like to learn more information about what it is like to work in the US. (example: How to find jobs, how to do applications, what is orientation like?)

Practice an interview over the phone/video chat

Create a resume for future jobs

Other:

Required

Have you done this form before? *

No, I have not done this form before

Yes, I have done this form this year

Yes, but it has been more than 1 year ago.

Clear form

Never submit passwords through Google Forms.

This form was created inside of Community Action of Southern Kentucky.

Does this form look suspicious? Report

Forms