Intake Form
This intake form collects your personal information, education, certifications, and career goals to help us better assist you in finding employment opportunities. Your data will only be used for professional purposes within Career Focus Inc. and will remain confidential. Thank you for trusting us to support your career journey.
First Name
*
Last Name
*
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Other
Home Address:
*
Include City, State, and Zip Code
Phone Number
*
Email Address
*
Are you currently employed?
*
Yes
No
Degree
*
No Diploma
High School Diploma / GED
Associate Degree
Bachelor's Degree
Other
What are your short-term goals?
*
What are your long-term goals?
*
Are you interested in job training or skill development?
*
Yes
No
Support Services & Needs: (Do you have any barriers to employment? Check all that apply)
*
Lack of work experience
Transportation issues
Childcare responsibilities
Health-related concerns
Legal history
Other
Do you need assistance with any of the following?
*
Resume Writing
Job Search Assistance
Interview Preperation
Career Counseling
Financial Literacy
Other
How did you hear about Career Focus?
*
Are there any other resources or support you need?
*
I confirm that the information provided above is accurate to the best of my knowledge. I understand that Career Focus will use this information to provide career services and resources.
*
Yes
Signature
*
Submit
Should be Empty: