Career Center Customer Registration Form

Required items are indicated with asterisk *

We must collect additional personal information from customers to comply with federal reporting requirements for Workforce Innovation and Opportunity Act (WIOA) funded programs. The information is for WIOA purposes only. New York State Career Centers follow federal guidelines on handling and the protection of personally identifiable information. Auxiliary aids and services are available upon request to individuals with disabilities.

Auxiliary aids and services are available upon request to individuals with disabilities.

Customer Data

(Services are available to individuals above and below age 24)

Ethnicity/Race

Note: The Ethnicity and Race questions are voluntary. Information is confidential and will only be used for record keeping and affirmative action requirements. You will not be penalized if you do not want to answer.

Education

Note: IEP Diploma/Disabled with Certification disclosure is voluntary. You will not be penalized for nondisclosure of IEP Diploma/Disabled with certification of attendance/completion.

Employment

Military

Note: Veterans and "eligible spouses" receive priority of service.


Employment Preferences

$

Acceptable Job Locations

Note: If you are receiving Unemployment Insurance, you may be required to travel 1 hour by private transportation or 1 1/2 hours by public transportation.

Employment Objective

Employment objective/Type of work seeking

List most recent occupation(s)/job(s)

Work History

If you have job experience, please put as much detail in this section as possible to improve our chances of helping you find work. Enter the most recent employment first. Complete all required items for each employer.

Work History 1
$

Trade Adjustment Assistance (TAA)

Driver's License

Certificates/Licenses

Schools

Job Skills and Qualifications

*List at least one

Include skills and abilities that you used in your job(s), volunteer work, personal experiences, or that you have acquired through school or training. Examples: laboratory techniques, carpentry, welding, ability to read blueprints, typing, and computer skills such as word processing software, programming languages, or computer assisted design. Also, include languages in which you are fluent.

The Workforce Innovation and Opportunity Act Title I Financially Assisted Program is an Equal Opportunity Employer/Program. Auxiliary aids and services are available upon request to individuals with disabilities