WORK Center application

Date - must be mm/dd/yyyy format * Required
Date Format: 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 - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
Age
Gender at birth
Selective Service registration (males only)
Disability
Citizen / permanent resident * Required
U.S. veteran
Employment Information
Employment status * Required
Number of weeks unemployed (within the last 26 weeks)
Received a termination / layoff notice from last job or displaced homemaker
Reason for not working
Unable to work for any of the following COVID-19-related reasons:
Job title
Actual date of layoff - must be mm/dd/yyyy format
Date Format: 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
Receiving SSI
Receiving RCA
Receiving GA
Receiving food stamps
Income information
Family size
Family income during the last six months
Education information
High school drop-out
Highest school grade completed
Individual
Currently meets the following:
CalJOBS
Have you registered in CalJOBS?
Ex-offender
Homeless
What services are you interested in?
- Resume assistance
- Job search assistance
- WORK Center information
- Vocational training
Check all that apply.
If you selected job search assistance, select your first choice:
If you selected job search assistance, select your second choice:
If you selected job search assistance, indicate your available days.
If you selected job search assistance, indicate your available hours.
If you selected vocational training, indicate the type of training.
CAPTCHA

Contact information

Demographic information

Employment Information

Public assistance

Income information

Education information

Individual