Phone *
Email *
Date of Birth *
Number of members of the household at this address * 1 2 3 4 5 More than 5
Current total household income (yearly) * $0-$5,000 $5,000-$10,000 $10,000-$20,000 $20,000-$30,000 $30,000-$40,000 $40,000 or more
Education Level Did not complete high school High school diploma or GED Some college, no degree AA or AS degree BA or BS degree Graduate degree
I am currently employed * Yes, full time Yes, part time No
Current Employer(s) and position(s)
How long have you been employed? * Less than one month 1-3 months 3-6 months 6 months to a year 1-2 years 2 or more years
How long have you been unemployed? * Less than one month 1-3 months 3-6 months 6 months to a year 1-2 years 2 or more years
I have never had a job because: I am in high school so I am focusing on school/athletics. I am in college so I am focusing on my grades. I have family obligations that keep me from being emplyed. I have a disability that prevents me from working. I have applied but have not gotten any responses. I haven't really tried yet. I can't get to work. I'd rather describe why.
Describe why you have never had a job.
Additional information about your current situation