WIOA Interest & Eligibility (Eng)

Disclosure: All information provided is confidential and for internal use only
Para el formulario en español, haga clic aquí.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County

Alameda CountyContra Costa CountyMarin CountySan Francisco CountySan Mateo CountySanta Clara CountySanta Cruz CountySolano CountySonoma CountySan Joaquin CountyNapa CountySacramento CountyCalaveras County
Have you attended or watched a WIOA Orientation?*

YesNo
Apply for the WIOA program through San Pablo EDC for help finding a job, career advancement, job training and potential funding for career education. With WIOA you can access free one-on-one career counseling, career planning, resume help, and networking and interview coaching to sharpen your job searching skills.

Attend a WIOA Orientation via Zoom

Tuesdays, 10:00 AM, starting january 9, 2023

www.tinyurl.com/SpedcWIOA | Meeting ID: 881 9069 5708 | Or Call In: +1 669-900-9128

OR

Watch Pre-Recorded WIOA Orientation available on-demand anytime

Online

www.sanpabloedc.org/WIOA
Are you at least 18 years of age or older?*

YesNo
Since you do not meet the age requirement for adult WIOA program, please visit https://www.wdbccc.com/youth-young-adult-services/ for WIOA youth services.
Are you a U.S. citizen or do you have legal right to work?*

YesNo
Thank you for your interest in the WIOA Program. Unfortunately, you do not meet the eligibility requirements for this program at this time.
Which of the following best describes your current situation?*

UnemployedUnderemployedOther
People assigned the male gender at birth born after 1959 must be registered with the Selective Service* unless they arrived in the US after the age of 25. If it applies to you, are you registered with the Selective Service?*

YesNoNot sureNot Applicable
Please visit https://www.sss.gov/register/ to register for the Selective Service.
To verify registration please visit https://www.sss.gov/verify/ or call 1-888-655-1825.

If you were born before 1959 or arrived to the U.S after age of 25, call and request an exemption letter in order to apply for the WIOA program
Have you created an individual user profile on the CalJOBS website: www.caljobs.ca.gov?*

YesNoNot sure
Unfortunately, we cannot proceed with your request at this time. Please click here to register
If you have forgotten your user name and/or password, please click Retrieve User Name or Password
WIOA ASSESTMENT QUESTIONARE
What are your employment and training goals?*
Are you working?*

YesNo
Full-time or Part-time?*

Full-timePart-time
What happened to your last job?*
How long have you been unemployed?*
Where did you work and in which position?*
What kind of work experience do you have?*
Are you collecting Unemployment Insurance (UI), or have exhausted UI benefits or been denied UI?*
Are you likely to return to your previous industry at another company?*
How many people are in your household (this includes people that you share expenses with)?*
Do you file your own taxes?*

YesNo
Please provide your best estimate of your income for the last 6 months. This includes cash assistance, Social Security Insurance (SSI) and Unemployment Insurance (UI), and other assistance.*
How are you supporting yourself/paying for your expenses?*
Are you receiving Public Assistance?*

YesNo
Please select the public assistance you are receiving*

Temporary Assistance for Needy Families (TANF)Supplemental Security Income (SSI) recipient:General Assistance (GA) recipientSupplemental Nutrition Assistance Program (SNAP)Refugee Cash Assistance (RCA) recipientSocial Security Disability Insurance (receiving or received in the last 6 months)
Please select which of the following applies to you.*

Veteran or in the MilitarySpouse of a VeteranDoes not apply
Is Military Spouse is disabled due to duty, Deployed or active duty?*

YesNo
Are you or have you been justice-impacted?*

YesNo
Please specify which one applies to you*

ArrestedIncarceratedOn ParoleIn ProbationOther
Do you have any documented permanent disabilities?*

YesNo
Are you unhoused?*

YesNo
Please specify which one applies to you*

ShelterResidential Treatment FacilityLiving in carLiving on the street
Did you graduate High School or obtain a GED or High School Equivalency?*

YesNo
Is English your first language?*

YesNo
Do you ever have difficulty understanding or communication in English?*

YesNo
What is your preferred primary language if other than English?*
Should be Empty:

Disclosure: All information provided is confidential and for internal use only

WIOA ASSESTMENT QUESTIONARE