Name: Career Center Orientation
Start: 2022-06-03T10:00:00-04:00
End: 2022-06-03T11:00:00-04:00

Screening Form

Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Phone*
Email*
Which orientation date would you like to attend?*
Orientations are required to register for services. Please select which day and time works better for you. A team member will respond with the next available orientation date.
Interest (Check all that apply)*
- Funding
- Career Services
- Resume Development
- Job Search Assistance
- Individual Career Counseling
- Workshops
- Resource Room
- Other: Please specify below
Please briefly describe your other interests.
Have you previously registered with the Rockland County Career Center or Rockland Works?*
Veteran Status*
Are you in receipt of Unemployment benefits?*
Do you receive Public Assistance benefits through the Dept. of Social Services?*
Type of Public Assistance
Other type of public assistance
Additional Comments*
How did you hear about Rockland Works?*

Screening Form

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