CCSCFormsWorcester

INA WORCESTER FORM

Name *

First

Last

Phone Number

JobSeeker ID Number *

Email *

Please enter your email, so we can follow up with you.

I Watched the Career Center Video on Date *

Confirmations

I acknowledge that I have reviewed the Training Opportunities (Section 30) flyer and am aware that the application deadline is no later than the 20th payable week of my unemployment claim.
I acknowledge that I have reviewed the information provided in the Complaint Brochure.

Which partner agency (ies), if any, are you currently receiving or using services from? (Check all that apply)

What supportive services / community resources, if any, do you need information about? (check all that apply)

Based on your situation, you may be eligible for specialized services. (check all that apply)

What training programs, if any, would you like to get more information about? (check all that apply)

Higher education, ABE, ESL or HSE
WIOA ITA / Adult & Dislocated Worker Program*
National Dislocated Workers Grant program*
TRADE program*
Basic computer skills, or skills with applications like MS Word, Excel, PowerPoint, Access, Outlook, QuickBooks
* Dependent on funding and eligibility requirements

What assistance are you looking for to help with your job search? (check all that apply)

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