• Please answer these questions for our staff to best serve your needs?

  • Please note that having a criminal record is a requirement for receiving our services.

  • Have you ever been arrested?
  • Do you need legal assistance?

  • TEAMWORK ENGLEWOOD INTAKE FORM

  • CONFIDENTIALITY NOTE: THE TEAMWORK ENGLEWOOD STAFF IS COLLECTING THIS INFORMATION TO IMPROVE OUR ABILITY TO CONNECT YOU TO THE NECESSARY RESOURCES. ALL OF THIS INFORMATION IS CONFIDENTIAL.

  • TODAY'S DATE
     / /
  • Format: (000) 000-0000.
  • Do you know your Chicago Neighborhood ?

  • Please provide TWO emergency contacts who can be contacted on your behalf if we cannot reach you.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • ABOUT INCARCERATION

  • When was the last time you were arrested?
     - -
  • Where was your most recent sentence served ?
  • What date will you complete probation or parole?
     - -
  • Please tell us who referred you here:
  • What is your gender?
  • What is your ethnicity?
  • Do you need assistance with any of the following? Check all that apply:
  • What is the highest level of education you have completed?
  • Do you receive income from any of the following sources?

  • Employment History

  • Date of employment
     / /
  • Dates of employment
     / /
  • What type of work are you looking for? Check all that apply:

  • RELEASE OF INFORMATION

  • I, the undersigned, authorize Teamwork Englewood to disclose in good faith any information they may have regarding my qualifications and fitness for employment and/or employment training. I authorize Teamwork Englewood to share my information with grant funders and other stakeholders.

    I will hold Teamwork Englewood, and any other persons working on their behalf forwarding references, free of liability for the exchange of this information and any other reasonable and necessary information incident to the employment process.

  • FOLLOW-UP AGREEMENT

  • I, the undersigned, agree to follow up with Teamwork Englewood in 30-day increments up to 180 days from this date to update them regarding my employment status and any other changes to my life with which they may assist me. I agree to follow up via phone call and/or in-person visits and with supporting documents when

  • PHOTO RELEASE

  • Do you consent to Teamwork Englewood using pictures of you in social media and/or promotional capacities? Your answer will not affect your ability to receive our services.

  • Do you consent to Teamwork Englewood using pictures of you in social media and/or promotional capacities? Your answer will not affect your ability to receive our services.

  • TWE Legal Clinic | Sealing & Expungement Intake

    CONFIDENTIALITY NOTE: THE TEAMWORK ENGLEWOOD STAFF IS COLLECTING THIS INFORMATION TO IMPROVE OUR ABILITY TO CONNECT YOU TO THE NECESSARY RESOURCES. ALL OF THIS INFORMATION IS CONFIDENTIAL.
  • Please select all of the legal assistance you are in need of:
  • For any offense you are trying to expunge or seal, were you detained or arrested by the police as a juvenile, or charged in juvenile court?
  • For any offense that you are trying to expunge or seal, were you charged in federal court?
  • For any offense you want to expunge or seal, were  you charged, but later acquitted or released without  being convicted?
  • Do you take care of anyone other than children  (grandparents, foster children, family members)?

  • Financial Questionaire

  • Required Documents

    Photo ID
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  • Expiration Date
     - -

  • Required Documents

    Social Security Card / Birth Certificate
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  • Teamwork Englewood Risk/Needs Assessment Tool for Prospective Clients

    This survey was developed by Teamwork Englewood staff, based on the First Step Act of 2018. Please fill this out to the best of your knowledge so that we can provide you with resources and employment recommendations that are best for you.
  • How many total convictions are on your record (any):
  • How much time have you taken to determine your reentry, education, work, and social goals:
  • Rank the stability of your immediate family relationship:
  • If offered, how likely are you to complete training (with a stipend) that will enhance your social skills:
  • Describe your current living situation:
  • What kind of job history do you have?
  • If offered, I would engage in one-on-one counseling to address my past traumas:
  • I feel that I have a strong support system within my family and social circles:
  • Are you an S.O. ?
  • Do you have any current pending cases?
  • Are any of these a barrier to your ability to get to work or complete a job? Select all that apply
  •  
  • Should be Empty: