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Career Support Information Form
Select a date
First Name
Last Name
Email
Preferred Phone
Education and Training
Select your highest level of education:
GED
High School Diploma
Technical
Some College
Associates
Bachelors
Masters
Are you currently taking classes?
Yes
No
Name of School
Miscellaneous
How do you get to work/school?
Own Car
Bus
Walk
Carpool
Do you have access to a computer?
Yes
No
Do you have access to internet?
Yes
No
Skills
Office:
Reception
Data Entry
Typing
Bookkeeping
Word
PowerPoint
Outlook
Customer Service
Excel
Typing Words Per Minute
Retail/Food Service/Hospitality:
Cashier
Sales
Grocery
Manager
Server
Customer Service
Food Prep
Retail
Housekeeping
Miscellaneous
Accounting
Security
Child Care
Law Enforcement
Education
Banking
Cosmetology
Other
For Other, please specify:
What is it that you are hoping to get out of today's appointment?
Are you currently employed?
Yes
No
Full time or part-time?
Yes
No
Last Three Employers
Company One
Position/Job Title
Start Date
End Date
Reason for Leaving:
Company Two
Position/Job Title
Start Date
End Date
Reason for Leaving:
Company Three
Position/Job Title
Start Date
End Date
Reason for Leaving:
My best job ever was....
Why?
Do you need assistance with any of the following?
Resume
Cover Letter
Interview Skills
Courses
Training
Scholarships
Submit
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