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WIOA Application Intake Request

Are you a Richland County resident?
Yes
No
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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