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WIOA Application Intake Request

Which county?
Richland County
Crawford County
Date and time
Month
Day
Year
Time
HoursMinutes
Are you employed?
Yes
No
Were you laid off from last job?
Yes
No
Did you receive a lay-off notice?
Yes
No
Are you receiving UC?
Yes
No
Have you ever received JTPA/PIC/DMARWWIA assistance?
Yes
No
Are you (check all that apply):
Do any of these same people work?
Yes
No
Do you or anyone in your household receive (check all that apply):
Do you or anyone in your household receive social security?
Yes
No
Do you have a high school diploma or GED certification?
Yes
No
Do you have any occupational licensure, certificate, training, degree, or journeyman's card?
Yes
No
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