CAREER AND NEEDS ASSESSMENT

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Who referred you?* This field is required.
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Google
LinkedIn
Facebook
Instagram
Twitter
Department of Labor (DOL), WIOA
SNAP
TANF
Housing Authority
Other
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If Other, Explain
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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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Mailing Address* This field is required.If you are homeless, enter the nearest address of a church or other property
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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LinkedIn URL Address* This field is required.
N/A if you have none
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What is your residential status?* This field is required.
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Please Select
Currently Renting
Looking to Rent
Home Owner
Looking to Own a Home
Emergency Housing (Domestic Violence Abuser or Victims)
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1. What is your employment status?* This field is required.
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Employed
Self-Employed (Business Owner, Entrepreneur)
Unemployed
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1a. How many days, months, or years of total work experience do you have?* This field is required.
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2. Which assumption of the US Workforce best suits you?* This field is required.
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I think the idea of determining my value on the job by an hourly wage is a Great.
I think the idea of a flexible job is one that compensates me by giving me deadlines to fulfill my responsibilities without managing my time.
I am mentally or physically unable to work
Do you like the government and employer structure that determines pay, benefits, training within human resources
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2. World of Business
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2. Workforce
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2. Prayer
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3. Think back. Which of the following aligns closest with your opinion of your previous employer management style?* This field is required.
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My managers were sharp, disciplined with time, and knew what they were doing. I'd be a great manager too!
My managers micro-managed me but I like that kind of supervision because I don't like working by myself.
I never had a job
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3. World of Business
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3. Workforce
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3. Prayer
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4. What do you like about working for an employer?* This field is required.
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I like that I can expect a paycheck frequently even though I know my employer can end my employment with or without cause.
I like it but I prefer to have control of how much income I generate. Employer wages are often set.
I never had a job or I don't like working
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4. World of Business
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4. Workforce
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4. Prayer
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5. If I could change the employer structure, I would...* This field is required.
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not change anything. I like the current employment structure of paying me by the hour
let compensation be determined by the value the employee produces for the employer
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5. World of Business
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5. Workforce
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6. Were you ever bored with your job?* This field is required.
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Yes
No
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6. World of Business
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6. Workforce
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7. Check all of the industries you've worked in.* This field is required.
Food and Beverage
Agriculture
Arts, Entertainment & Recreation
Banking, Finance & Insurance
Wellness, Healthcare & Home Health
Manufacturing
Professional Services
Real Estate
Retail
Transportation
Wholesale
Waste Management & Disposal
Mining, Quarry & Utilities
Education
Advertising, Engineering & Related Services
Auto Repair & Mechanic
Beauty, Cosmetics & Salon Services
Business Consulting & Coaching
Commercial & Residential Services
Childcare
Counseling & Therapy
Distribution & Transportation of Goods
Farming & Livestock
Fine Arts, Artisan, & Craftwork
Fishing & Hunting
Forestry
Funeral & Death Care Services
Media & Publishing
Information Technology
Nonprofit
Personal Care Services
Photography & Video Services
Public Relations & Communications
Recruiting & Staffing
Restaurant & Bar
Rental & Leasing
Social Assistance & Family Services
Travel, Hospitality & Tourism
Warehousing
Website Development
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8. Are you a Leader by nature?* This field is required.
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Yes
No
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8. World of Business
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8. Workforce
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9. Which of the following emotions hinders you when you think of business?* This field is required.
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I know business, I'm just shy
I am scared to fail
I have no support if I take risks
I'm not going to lie, I am lazy
I often procrastinate when I think about getting things done
I haven't been exposed to much to feel anything
None of the above
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9. World of Business
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9. Workforce
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10. Which of the following makes you nervous?* This field is required.
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Being the first one to say hello to your new neighbor
Walking to the front of a large, crowded room to receive your reward
Walking through a crowded mall
Being the guest speaker
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10. World of Business
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10. Workforce
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11. Have you ever had a Business idea come to mind?* This field is required.
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I never received a business idea for business nor ministry.
I still have the vision in my mind
I own a business that needs support
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11. World of Business
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11. Workforce
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12. How do you manage finances?* This field is required.
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I don't do well with managing finances
I manage finances well and I stick with budgets I create
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12. World of Business
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12. Workforce
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13. If you are in debt, how do you respond?* This field is required.
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I create a plan to clear the debt and stick to it
I create a plan but may not stick to it because am not good with finances
If bill collectors are not calling me, emailing me, or mailing me, I am not going to pay the debt
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13. World of Business
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13. Workforce
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14. Name of the last company you worked for* This field is required.
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15. Separation date* This field is required.
Date
Month
Day
Year
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16. Reason for Separation* This field is required.
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Poor workplace performance
Insubordination
Stealing company time
Simply just not a good fit
I resigned
Other
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If other, explain
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17. Contact person for HR at last place of employment* This field is required.N/A if none
First Name
Last Name
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18. Phone Number* This field is required.
Please enter a valid phone number.
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19. Website or social media url for the last employer you worked for* This field is required.
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Do you currently receive any of the following public assistance?* This field is required.
SNAP (Supplemental Nutrition Assistance Program)
TANF (Temporary Assistance for Needy Families)
Pregnancy Medicaid
Medicaid
Medicare
WIC (Women Infants and Children)
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What is your Annual Income Level?* This field is required.
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0-$20,000
$20,000-$50,000
$50,000-$100,000
$100,000-$250,000
$250,000 or more
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What is your Parental Status?* This field is required.
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Please Select
Not applicable
Primary Custodial Parent
Legal Guardian
Join Custody
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Do you owe child support?* This field is required.
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Yes
No
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Do you have a Criminal Record?* This field is required.Check all that apply
Traffic Tickets
Misdemeanor
Felony
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Upon submission AI will calculate your responses will connect you to jobs, resources, and/or housing On-Demand.* This field is required.
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I acknowledge
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Total Score for World of Business
62
Total Score for Workforce
63
Total Score for Prayer
64
Total Score for Company Assessment
Should be Empty: