Request for LWIA 14 Services Request for LWIA 14 Services Name * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone Number * Email * Age * Family size * Employment Services What type of job are you seeking? If unsure, how can we assist you? (select all that apply) Job referrals Job search assistance Mock/virtual interviews Job coaching/job search workshop Work Readiness Workshop Application completion Training Services What type of training are you seeking? If unsure, how can we assist you? (select all that apply) Computer classes Career advising Career planning assistance Training opportunities Educational opportunities English as a Second Language Internship - Work-based learning – On-the-Job training Tuition assistance/ financial aid Apprenticeship Other services Computer/internet access Unemployment benefits Food assistance Medical assistance Adequate place to sleep Elder care Childcare Other Tell us about yourself Which of the following best describes your current employment status: (select all that apply) Never employed Unemployed Self-Employed Underemployed Employed full-time or part-time Employed but received notice of layoff/military separation Laid off due to COVID Select the highest grade of education completed Did not complete high schoolIn high schoolIn GED or Equivalency programHigh School Diploma/GED or Equivalent Certificate Please list post-secondary schooling (education or training beyond high school) if applicable Military service: (Please select the best applicable option) Active-duty militaryPrior military service/veteranTransitioning service memberSpouse of a veteranNot in the military or a veteran Annual family income (Select the best applicable option) Less than 24,99925,000-34,99935,000-44,99945,000 or moreUnknown Are you on: Snap TANF Both Unknown Please check any challenges that may hinder you from obtaining employment (check all that apply): Age Housing Access to technology Job search skills Transportation Childcare Work history Limited English Homeless Criminal record Health Low computer skills Single parent Unsure how to ask for work accommodation Lack high school diploma/GED or equivalent certificate Medical condition Mental health condition Returning citizen Foster care Low income Uniforms/work clothing Tools What is 2+3? Just making sure you are human and not a robot. Submit If you are human, leave this field blank.
