WORK Center application

Date * Required
MM slash DD slash YYYY
Contact information
Name * Required
First Last
Address * Required
Street Address Address Line 2 City State ZIP Code
Email * Required
Phone * Required
Demographic information
Date of birth * Required
MM slash DD slash YYYY
Age * Required
Gender at birth
Selective Service registration (males only) * Required
Disability * Required
Citizen / permanent resident * Required
U.S. veteran * Required
Employment Information
Employment status * Required
Number of weeks unemployed (within the last 26 weeks) * Required
Received a termination / layoff notice from last job or displaced homemaker * Required
Reason for not working * Required
Job title * Required
Actual date of layoff * Required
MM slash DD slash YYYY
Employer name
Employer address
Street Address Address Line 2 City State ZIP Code
Hourly wage
U.I. claimant * Required
Public assistance
Receiving TANF * Required
Receiving SSI * Required
Receiving RCA * Required
Receiving GA * Required
Receiving food stamps * Required
Income information
Family size * Required
Family income during the last six months * Required
Education information
High school drop-out * Required
Highest school grade completed * Required
Individual
Currently meets the following:
CalJOBS * Required
Have you registered in CalJOBS?
Ex-offender * Required
Homeless * Required
What services are you interested in? * Required
- Resume assistance
- Job search assistance
- WORK Center information
- Vocational training
Check all that apply.
If you selected job search assistance, select your first choice: * Required
If you selected job search assistance, select your second choice:
If you selected vocational training, indicate the type of training. * Required
CAPTCHA

Contact information

Demographic information

Employment Information

Public assistance

Income information

Education information

Individual