WIOA Needs Assessment

SECTION 1: EMPLOYMENT EXPECTATIONS

Desired Goals *
Employment Type *
Full or Part Time (Check all that apply) *
Desired Salary *
Shift Preference *
Benefits *
Desired needs toward employment *
Are you seeking training? *

SECTION 2: EDUCATION HISTORY

Highest Level of Education *
Are you Currently Enrolled in School? *

Certificates/Licenses/Degrees Attained

Type *
If your degree is from a different country, has it been evaluated in the US? *
Type
If your degree is from a different country, has it been evaluated in the US?
Type
If your degree is from a different country, has it been evaluated in the US?
Type
If your degree is from a different country, has it been evaluated in the US?

SECTION 3: BASIC SKILLS/EDUCATION FACTORS

Is English your primary language spoken at home? *
Do you require interpretation services? *
Are you currently enrolled in Adult Basic Education Courses? (IE: GED or Literacy Classes) *

SECTION 4: WORK READINESS

Do you have Dependent Care Needs? *
If yes, check all that apply *

Outline your transportation situation below

Driver’s License *
Driver’s License Endorsements *
Automobile *
Please give details about your access to telephone communication (Check all that apply) *
Do you have a professional voicemail? *
Please give details about Work Attire Needs (Check all that apply) *
Are there other factors preventing you from gaining employment? *
If yes, please specify *
Do you need any special accommodations to work? *

SECTION 5: EMPLOYMENT/JOB SEARCH

Do you have a resume? *
Do you target your resume for each job applied for? *
Do you have an elevator speech? *
Which social media job site are you comfortable using? *
Are you proficient in the following computer programs? *
Are you interested in Self-Employment? *
Do you participate in volunteer opportunities? *

SECTION 6: OCCUPATIONAL TRANSFERABLE SKILLS

Please check all skills that you feel you possess *

SECTION 7: LIVING ENVIRONMENT (Optional)

What is your current housing situation?
Are concerned about being able to pay monthly rent or mortgage for your housing within the next six months?
Do you feel safe, stable, and secure in your home environment?

SECTION 8: PERSONAL/FINANCIAL (Optional)

Do you have any financial issues or concerns?
Have you ever applied for or received public assistance?
If yes, please specify *