Mature Worker Connection (Tucson, Az)

Job Seeker Registration

Last Name: First Name: Middle Initial:
Address:
City: State: Zip Code:
Phone: Alternate Number:
E-Mail:

How did you hear about us?:

Education:
High School or GED Degree Attended College Number of Years
College/Graduate Degrees:
Licenses/Certificates:
Trade School:
Multi-lingual (Specify which languages you are proficient in other than English):

Work History - Last 3 Jobs:

Dates (From/To)	Organization (Include city & State)	Type of Work	Reason for Leaving

Work Preferences:
Full Time Part Time Temporary/Seasonal Project Work Home Based
Weekends Days Evenings - Other:

How far are you willing to travel for work?
What type of work are you looking for?

Are you legally authorized to work in the US?
Have you ever been convicted of a felony?
Are you a veteran?
Are you in need of special (reasonable) accommodations due to a disability?

Employment Related Services (Check all that you are interested in receiving):

Employability skills training	Computer skills
On-the-job training*	Work attire or uniforms*
Career counseling*	Veteran's employment program*
Internet job search/application skills
Vocational, workplace skills, or professional training*: (Specify)
Other:

* Those services marked with an "*" are available for individuals who qualify. All other services are available to everyone.

Additional Comments:

I hereby attest that the information submitted on this registration is true to the best of my knowledge.

Job Seeker EEO Identification:
The information requested below is used to assist us in our compliance with Federal/State funding and equal opportunity record keeping and reporting. Your response will be used only for those reporting purposes and will not be used in any way to determine your eligibility for employment.

Current Age:
Gender:
Race / Ethnic Data:

Explanation Race / Ethnic Data:

Native American or Alaskan Native: Persons having origins in any of the original peoples of North America and maintain cultural identification through tribal affiliation or community recognition.

Hispanic, Latino or Spanish: All persons of Mexican, Puerto Rican, Cuban, Central or South American culture or origin, regardless of race.

Black or African American: Persons having origins in any of the black racial groups of Africa.

Native Hawaiian or Pacific Islander: Pacific Islands including islands of the Indian subcontinent, for example, China, Japan, the Philippines, Samoa, India, and Pakistan.

Asian: Persons having origins in any of the original peoples of the Far East, Southeast Asia.

White /Caucasian: Persons having origins in any of the original peoples of Europe, North-Africa or the Middle East