CNWI Contact Form

Name *

First Name Last Name
Are you looking for full time employment? *

Yes No
Do you have a phone? *

Yes No
Do you have an email you can access? *

Yes No
To sign up, you must have either a working phone number or email address so that we can contact you.
If you do NOT have either a phone number or email, please call us at 216-696-5707 to receive more information.
Phone Number

Area Code Phone Number
Would you prefer to be contacted via phone call or text message? *

Phone Call Text Message Both Call and Text are OK
Email
example@example.com
When is the best time to contact you?

Morning Afternoon Evening
City or Neighborhood *
Example: Brooklyn, Cleveland Heights, West Park, etc
What kind of career are you interested in?
Have you participated in a workforce program before? *

Yes No
What was the workforce program? (Optional)
What are the barriers to securing employment? Check all that apply

Transportation Childcare Clothing Criminal History Disability Mental Health Addiction Homelessness Skills Age
Do you currently receive any of the following benefits or any other cash benefits that limit your allowed income?

Social Security Disability
Are you filling out this form on behalf of someone? *

Yes No
Information entered by:
Location:
Additional Notes:
Should be Empty: