Career Services Intake Form
Please click the arrow icon next to each section title (e.g., "Employment Status and Needs," "Financial Well-being," or "Learning and Growth Opportunities") to expand the section and view the questions. Once expanded, review each question carefully and select the appropriate answer(s) by clicking the radio buttons or checkboxes, or type your responses into the provided text boxes for open-ended questions. Make sure to expand and complete all sections before submitting the form to ensure your responses are comprehensive. Once finished, double-check your answers and click the "Submit" button at the end of the form. If you have any questions or experience any issues, please contact us for assistance. Please email questions to workforce@cul.org.
IDENTIFICATION
Personal Information
Legal Name
*
Prefix
First Name
Middle Name
Last Name
Date of Birth
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Month
-
Day
Year
Date Picker Icon
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employment Status and Needs
Are you currently employed?
*
Yes
No
TANF/ALICE Assessment: Are you currently receiving TANF, or are you classified as ALICE? (TANF (Temporary Assistance for Needy Families) is a federal assistance program providing cash aid to low-income families. ALICE (Asset-Limited, Income-Constrained, Employed) refers to individuals or households who are working but struggle to afford basic necessities.)
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TANF
ALICE
Neither
Do you have a resume?
*
Yes
No
Yes, but it needs updating
What type of work are you interested in? (Select all that apply)
Administrative/Clerical
Customer Service
Warehouse
Healthcare
Information Technology
Other
What is the minimum hourly wage/salary you are willing to accept?
What is your computer literacy level?
Beginner
Intermediate
Advanced
Expert
I have no computer skills
Which of the following computer skills can you confidently perform? Select all that apply.
Use email (send, receive, and manage attachments)
Browse the internet (searching, navigating websites)
Use word processing software (e.g., Microsoft Word, Google Docs)
Create spreadsheets (e.g., Microsoft Excel, Google Sheets)
Use presentation software (e.g., Microsoft PowerPoint, Google Slides)
Use video conferencing tools (e.g., Zoom, Microsoft Teams)
Perform basic troubleshooting (e.g., restart a program, update software)
Use graphic design or photo editing tools (e.g., Canva, Adobe Photoshop)
Perform programming or coding tasks (e.g., Python, HTML)
Manage files and folders (e.g., saving, organizing, or retrieving files)
None of the above
Which career services do you need assistance with?
Writing a Resume
Crafting a Cover Letter
Identifying My Skills
Improving Computer and Digital/Virtual skills
Job Application Process
Interview Preparation
Life Essentials Support
To provide comprehensive support, we offer assistance in various areas that may affect your employment journey. The following questions are optional and will remain confidential.
Financial Well-being
Do you have concerns about your financial stability?
Yes
No
Prefer Not to Say
Other
If yes, would you like information on financial resources and support?
Yes
No
Are you experiencing any challenges with employment due to legal issues?
Yes
No
Prefer Not to Say
Other
If yes, would you like assistance or referrals for legal support?
Yes
No
Learning and Growth Opportunities
What is the highest level of education you have completed?
Less than high school
High school diploma or GED
Some college
Associate degree
Bachelor's degree
Graduate or professional degree
Trade or vocational certification
Prefer not to say
Are you interested in pursuing further education or training?
Yes
No
Maybe
Other
If yes, in what field or area?
Health and Wellness Resources
Do you have access to healthcare services?
Yes
No
Prefer not to say
Would you like information about resources for any services you do not currently have access to?
Yes
No
Which of the following health and wellness services do you currently have access to? (Check all that apply)
Primary care (e.g., a family doctor or general practitioner)
Urgent care or walk-in clinics
Mental health services (e.g., counseling or therapy)
Dental care
Vision care
Prescription medication services
Preventive care (e.g., vaccinations, screenings)
Emergency medical care
None of the above
Prefer not to say
Housing and Transportation Support
Do you have access to healthcare services?
Yes
No
Prefer not to say
Would you like information about resources for any services you do not currently have access to?"
Yes
No
Family, Friends, and Community Connections
Do you have access to childcare services, if applicable?
Yes
No
Prefer not to say
Are you experiencing any challenges (e.g., discrimination, language barriers) that affect your employment?
Yes
No
Prefer not to say
Would you like assistance or referrals to support services?
Yes
No
Do you have a supportive network of family or friends?
Yes
No
Prefer not to say
Additional Programs and Services
Are you interested in any other Columbus Urban League programs? (Select all that apply)
*
Journey to Wealth (Credit Building)
Housing Accelerator (Housing/Rental Counseling)
MBAC (Minority Business Assistance Center)
Home Buyer Education (First-Time Homebuyers Class)
Expungement Resources
My Brothers Closet
Not at this time
Other
How did you hear about the Columbus Urban League?
*
Social Media
Friend or Family
Online Search
Community Event
Referral from another organization
Other
Demographic Information
The following questions are optional and used for statistical purposes to improve our services. Your responses are confidential.
Race/Ethnicity
African American/Black
Caucasian/White
Hispanic/Latino
Asian/Pacific Islander
Native American
Middle Eastern
Multiracial
Prefer not to say
Other
Gender Identity
Male
Female
Non-binary
Prefer not to say
Other
Scheduling
Which career services office hours would you like to attend?
Tuesday at 11:00 AM
Thursday at 1:00 PM
I cannot attend office hours and would like to schedule an appointment.
Consent to Contact and Submission
By submitting this form, you provide your consent to be contacted by the Columbus Urban League through phone, email, or other communication methods regarding our programs, services, events, or other related opportunities. Your consent includes receiving updates, reminders, or follow-up communications as necessary to support your engagement with our organization.
*
I agree
Privacy Notice
Your information is confidential and will only be used to provide the services outlined by the Career Connect Hub and the Columbus Urban League. We are committed to protecting your privacy and ensuring your data is handled securely. For more details, please refer to our Privacy Policy.
Please verify that you are human
*
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