Individualized Career Services Packet Instructions:

THIS FILE MUST BE DOWNLOADED TO YOUR COMPUTER

IN ORDER TO BE FILLED OUT PROPERLY PLEASE SEE DOWNLOAD INSTRUCTIONS ON OUR WEBSITE

The Individualized Career Services Packet is intended to help staff determine an individual’s suitability and eligibility for services. Please print and complete the packet as thoroughly as possible.

Once Packet is complete you can:

1. Scan the entire packet to: info@sjcworknet.org

2. Save the completed electronic fillable PDF and submit to: info@sjcworknet.org

3. Mail the entire Packet to: 56 S. Lincoln Street Stockton CA 95203

4. Drop off the Packet at the Stockton WorkNet Center, 56 S. Lincoln Street Stockton Ca 95204 If you are unable to print or electronically fill out the packet, please call 209-468-3500 and a staff member will be able to assist you with completing the packet.

Welcome to WorkNetA Proud Partner of

America’s Job Center of California

IntensiveServiceProcess IntensiveServiceApplicationPacket√ Checkoffasyoucomplete:

• Orientation• Registeratwww.caljobs.ca.gov• IntensiveServiceApplicationReview• Certification/CASASTesting• ComprehensiveAssessment

(CareerScope&WorkKeys)• IndividualEmployabilityPlan

(withCaseManager)• CareerTrackorJobTrack• Employment

( )CompleteCalJobsRegistration

( )CompleteBackgroundWizardonCalJobs(printandattach)

( )AttachUpdatedCalJobsResume

( )CompletePre-eligibilityWorksheetforWIOA

( )CompleteandattachQuestionnaire

( )CompleteGenericApplicationlegibly

( )SelectiveServiceVerification(www.sss.gov)(ThisonlyapplyforMalesbornafter1960)

Upon completion of packet, return it to any WorkNet center. You will be contacted by phone and/or e-mail for the next step in your process. Please be advised that completing all of these steps does notguarantee you will be selected for training or additional services.

Customer Name: _____________________________Best contact # to reach you: ____________________

Last 4 of SS#_____________

**************************************************************************************************

FORSTAFFUSEONLY:

Receivedby:(StaffName)______________________________________(Date):_____________________

******************************************************************************************PacketAssignedto:(StaffName)________________________ Date:_______________________

ReviewedbyCaseManagerforpacketcompleteness:___________________________________________Complete,forwardedbacktoClericalStaff: ()JobTrack()CareerTrack ()NotYetInitial/Date:____________________

()ReferredOutReason:_______________________________________________________________________________________________________________________________________________________________________

******************************************************************************************PacketAssignedforCertification:_________________________ Date:________________________IfCertificationisnotScheduled,forwardedbacktoClerical:()NoShow()NoCall()Ineligible

Revised04/01/2020bpc

Pre-EligibilityWorksheetforWIOA

Name:___________________________________________________________________Date:___________________

AreyoucurrentlyreceivingCashAid,FoodStampsorGeneralAssistance? ( )Yes ()No

Areyoubetweentheagesof18-21? ( )Yes ( )No

Ifyes,haveyouobtainedyourhighschooldiplomaorGED? ( )Yes ( )No

AreyouacitizenoftheUnitedStates? ( )Yes ( )No

DoyouhavetherighttoworkintheUnitedStates? ( )Yes ( )No

AreyouamalebornonorafterJanuary1,1960? ( )Yes ( )No

Ifyes,areyouregisteredwithSelectiveService? ( )Yes ( )No

üIfyes,pleaseattachRegistrationprintoutfromwww.sss.gov,verifyingthatyouareregistered.

Wereyoulaidofforterminatedfromyourlastjob? ( )Yes ( )No

Ifyes,pleaseattachemployerletterorunemploymentverification.Areyoureceivingunemploymentinsurancebenefits? ( )Yes ( )No

Pleaseprovidethenumberinyourfamilycurrentlyresidinginthehouseholdincludingyourself._________Pleaseincludeonlyself,spouseandminorchildren(17&under)residinginhomerelatedtoyoubyblood,marriageoradoption.

FamilyIncome:Pleasecheckallthatapplyandentertheamountofincomereceivedforthepast6months.

Pleasebepreparedtoprovideverificationofeachsourceofincomeyouhavereceivedinthepast6months.Forwages,acceptabledocumentsincludeW-2,paystubwithYTDamountlisted.

Month YourWages

SpouseWages

SSARetirement

RegularPension/Retirement

SSASurvivors

ChildSupport

UIB CashAidAssistance

OtherCountableIncome

OtherNon-CountableIncome

123456Total

STAFFUSEONLY:AppearsEligible:()ADULT()DISLOCATEDWORKER()INELIGIBLE/REFERREDOUT

Revised04/01/2020BPC

QUESTIONNAIRE

Name:___________________________________________________________Date:__________________________

SERVICESDESIRED

( )IdentifyingCareerInterests&Goals

( )Skills&AbilitiesAssessment

( )CareerCounseling

( )LaborMarketInformation

( )HelpwithInterviewing

( )HelpwithResumeWriting

( )OntheJobTraining

( )JobSearchResources

( )VocationalTrainingOptions

( )UnemploymentInsuranceAssistance

( )FinancialPlanning

SocialServicesInformation:()Foodstamps()PublicAssistance()Medi–CalorHealthInsurance

( )VeteransServices (( ) )Farm Worker Services ( )Child Support

Other:____________________________________________________________________________________________

EDUCATION

HighSchoolDiploma/GED:()Yes()NoIfno,reasonfordroppingout:___________________________

Areyoucurrentlyattendingschool()Yes()NoIfyes,nameofschool:___________________________

Lastgradecompletedanddatelastattendedschool:__________grade__________date

Post-SecondaryEducation:()Yes()No Major:_________________________________________

PleaselistVocationalTrainingCertificatesyouhavereceivedevenifexpired:__________________________________________________________________________________________

Whatlanguagesdoyouspeakfluently?()English()Others_____________________________________

AreyouaVeteran?()Yes()No MilitaryTraining?()Yes()No

ListTrainingreceivedinMilitary:__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

Questionnairepage1of4revised03/29/19-bpc)

JOBREADINESS

EmploymentBackground:(checkifapplicable)

_______ Currentlyemployedandnotmakingself-sufficientwagetomakeendsmeet.

_______ Currentlyemployedandnothappywithcurrentemployment.

_______ Currentlyunemployed.

Ifunemployed,howlonghaveyoubeenunemployed?________________________________

Reasonforpresentunemployment?_______________________________________________

AreyouACTIVELYseekingemployment?()Yes()No

Ifyes,pleaseanswerthefollowing:

Haveyoueverhadyourresumecritiquedbysomeoneprofessional?_____________________

Howoften,doyousearchforwork?_______________________________________________

Whatkindofsearchdoyoudo?()newspaperads()onlinesites()doortodoor

()randomfromthephonebook()Other:_____________________________________

Whatkindofjobareyouseeking?________________________________________________

Whatskillsdoyouhaverelatedtotheworkyouareseeking?

___________________________

_____________________________________________________________________________

Whatexperiencedoyouhaverelatedtotheworkyouareseeking?

______________________

_____________________________________________________________________________

Otherskillsorexperienceyouhaveasidefromthosealreadylisted?_____________________

_____________________________________________________________________________

Indicatelowestwageyouwillaccept:______________________________________________

Questionnaire,Page2

Inyourobservationofyourself,please√thosethatbestdescribesyou:

√ Iam: √ Iam:

TeamPlayer,Iliketoworkwithateam Independentworker,Iliketoworkalone

Punctual,IamneverlateIamlateoftenduetolackoftransportationorotherissues.

Dependable,IrarelymissadayofworkImissworkoftenduetolackoftransportationorotherissues.

Socialperson,Iliketobearoundothersandliketohavecommunicationandinteractionduringmydayonthejob.

Iliketocomein,getmyworkdoneandgohomewiththemostminimalsocialinteractionaspossible

ItryhardtoreachmyhighestpotentialandIamalwayslookingforapromotionalopportunity.

Iamsatisfiedwithbeingfrontlinestaffanddon’treallytrytomoveup.

Inyourobservationofthecircumstancesyouarecurrentlyexperiencing,whichdoyoufeelmakeitdifficultforyoutofindorkeepajoborcompletetraining.Check√thosethatapply:

Iliveinanisolatedarea Myskillsarerusty. Ihavefinancialdifficulties

Iexperienceagediscrimination

TherearenojobsinmyfieldIlackadequatefood

Ilackconfidence Ihavenotelephone Ilackproperclothingforwork

IhavealowcreditscoreIlackrequiredtoolsforthejobIamqualifiedfor

Ihavebeenlongtermunemployed.

IcannotdecidewhattypeofworkIwant

Ineedchildcareassistance Ihavenotransportation

Ilackvocationaltrainingand/oreducation

Ihavegapsinmyemploymenthistory

Ilackmotivation

IamlimitedEnglishspeaking IlackfamilysupportIamunabletopassacriminalbackgroundcheck

Ihavenoworkexperience Ihavenoworkexperience Iamhomeless

Isthereanyotherinformationorsituationthatyoufeelmayimpactyourabilitytoobtainemploymentorattendtraining?Ifyes,pleaseexplain:

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Questionnaire,Page3

TRANSPORTATION

Doyouhavereliabletransportation?()Yes()No

Type:()Ihavemyowncar()Irelyontheuseofsomeoneelse’svehicle.

IfyouareseekingemploymentasaDriver,pleaseanswerthefollowing:

DoyouhaveacurrentvalidCAdriver’slicense?()Yes()NoClass:()C()B()AIfNo,explainwhy:_____________________________________________________________

HaveyoueverheldanyotherclasslicensebesidesaC(generallicense)inthepast?()Yes()No

Ifso,whatclassandwhydoyounolongerpossessthatlicense:

______________________________________

_________________________________________________________________________________________

Howfarareyouwillingorabletotraveltoacceptemployment?

()WithinSanJoaquinCounty(Stockton,Manteca,Lodi,Tracy)

()OnlyinthelocalcityIliveinwhichis_________________________________________

()OutsideofSanJoaquinCountyupto____________miles.

CHILDCARE

School Status—Please Check One ()Infanttopreschool( )elementaryschool( )middleschool( )highschool()outofschool()Infanttopreschool()elementaryschool( )middleschool( )highschool()outofschool()Infanttopreschool( )elementaryschool( )middleschool( )highschool()outofschool()Infanttopreschool( )elementaryschool( )middleschool( )highschool()outofschool()Infanttopreschool( )elementaryschool( )middleschool( )highschool()outofschool()Infanttopreschool( )elementaryschool()middleschool()highschool()outofschool()Infanttopreschool( )elementaryschool( )middleschool( )highschool()outofschool

Describeyourchildcarearrangement:

__________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

Thankyouforcompletingthisquestionnaire. Questionnaire,Page4

AgeNumber of Dependent Children:_______ Please Provide the following information for each child

NAME (LAST, M.I., FIRST)

PRE-EMPLOYMENT QUESTIONNAIREEQUAL OPPORTUNITY EMPLOYER

POSITION

SCHOOL

SUBJECTS OF SPECIAL STUDY/VOLUNTEER OR RESEARCH WORK/WORKSHOPS OR SPECIAL TRAINING/SKILLS

U.S MILITARY OR NAVAL SERVICE

NAME ADDRESS PHONE NUMBER BUSINESS YEARSKNOWN

RANK

HIGH SCHOOL

BUSINESS/TRADE/TECHNICAL

COLLEGE

GRADUATE

NAME AND LOCATION

NAME

CITY/STATE

COURSE OF STUDY DEGREE or DIPLOMA

ARE YOU EMPLOYED NOW? IF SO, MAY WE CONTACTYOUR PRESENT EMPLOYER

EVER APPLIED TO THISCOMPANY BEFORE?

YES NO

YES NO

WHERE? WHEN?

YES NO

DATE YOU CAN START SALARY DESIRED

PERSONAL INFORMATION

EMPLOYMENT DESIRED

EDUCATION

GENERAL INFORMATION

REFERENCES GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR

DATE

CURRENT ADDRESS CITY

CITY

STATE

SOCIAL SECURITY NUMBER

STATE

ZIP CODE

ZIP CODEPERMANENT ADDRESS (If different from current address)

PHONE NUMBER E-MAIL ADDRESS

NAME

CITY/STATE

NAME

CITY/STATE

NAME

CITY/STATE

APPLICATION FOR EMPLOYMENT

Please complete fully and accurately, listing your current or most recent employers first,continuing backward in time. if additional space is needed, please attach another page.

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that,if employed, falsified statement on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references listed to give you any and all informationconcerning my previous employment and any pertinent information they may have, personal or otherwise and releaseall parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of paymentof my wages and salary, be terminated at any time without any prior notice.”

AUTHORIZATION

EMPLOYMENT HISTORY

Employer’s Name

SIGNATURE DATE

Employer’s Telephone Number

Employer’s Address

City, State, ZIP

Supervisor’s Name

Reason for Leaving

Starting Hourly Wage Ending Hourly Wage

Employed From Job Duties:

Your Title

Duties cont.

To

Employer’s Name Employer’s Telephone Number

Employer’s Address

City, State, ZIP

Supervisor’s Name

Reason for Leaving

Starting Hourly Wage Ending Hourly Wage

Employed From Job Duties:

Your Title

Duties cont.

To

Employer’s Name Employer’s Telephone Number

Employer’s Address

City, State, ZIP

Supervisor’s Name

Reason for Leaving

Starting Hourly Wage Ending Hourly Wage

Employed From Job Duties:

Your Title

Duties cont.

To

Employer’s Name Employer’s Telephone Number

Employer’s Address

City, State, ZIP

Supervisor’s Name

Reason for Leaving

Starting Hourly Wage Ending Hourly Wage

Employed From Job Duties:

Your Title

Duties cont.

To

Employer’s Name Employer’s Telephone Number

Employer’s Address

City, State, ZIP

Supervisor’s Name

Reason for Leaving

Starting Hourly Wage Ending Hourly Wage

Employed From Job Duties:

Your Title

Duties cont.

To