NextSuccess Interest Form

NextSuccess Interest Form
AAWDC NEXTSuccess is here with jobs, internships, and trainings waiting for you! It's your personalized guide to discovering your career path and preparing for the future. Young Adults ages 18-24 can connect to services by completing the interest form below.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Do you want to receive texts about NextSuccess?*

YesNo
Email*
example@example.com
Are you an Anne Arundel County resident?*

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload proof of your address. Acceptable documents include driver's license, voter registration card, computer printout from government agency, food stamp award letter, Housing Authority letter, current lease, public assistance records, or current year school ID.

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Are you eligible to work in the US?*

YesNo
Please upload proof of eligibility to work in the US. Acceptable documents include birth certificate, voter's registration card, US passport, Alien Registration card, food stamp records, Naturalization certificate, or public assistance records.

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What industries are you interested in? (Please select all that apply)*

HealthcareIT/CybersecurityTransportation, Warehousing, LogisticsConstructionHospitality, Food Service, RetailOther
Please upload a copy of your resume if you have one.

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Are you currently enrolled in any other workforce programs? (Please select all that apply)*

SNAPTANFUnemployment InsuranceDivision of Rehabilitation Services (DORS)None of the Above
Please select any of the challenges below that make it difficult for you to find employment.*

Transportation IssuesHomelessDisabilityChildcareJustice InvolvedNone of the AboveOther
How did you hear about NextSuccess?*

Family/Friend MemberFaith-Based OrganizationSocial MediaRadio/SpotifyWebsiteSchool/Community Organization/State AgencyOther
What School/Community Organization/State Agency did you learn about NextSuccess from?*
Have you attended NextSuccess Program Informational Session?*

YesNo
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