OAS - Techcomi

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EMPLOYMENT EXPECTATIONS

Previous Career Area/Job Title/Industry*

Desired Goals: (Mark only one)*

Undecided

Immediate Employment Assistance (no job preference)

Employment in the same industry/occupation

Career Change

List Occupational Areas of Interest*

Employment Type (Check all that apply)*

Regular

Temporary

Seasonal

Contract

Volunteer

Internship

Apprenticeship

Full or Part Time (Check all that apply)*

Full Time (30 hrs or more)

Part Time

Desired Salary*

Hourly

Annually

Maximum Commute in Miles*

Shift Preference*

1st Shift

2nd Shift

3rd Shift

Split

Any

Rotating

Desired Needs toward employment*

Job Search Strategy / Guidance

Resume and/or Cover Letter Assistance

Completing Job Applications

Interviewing Assistance

Referrals to Employers

Job readiness Workshop

Help in Career Planning

Seeking Training Services

Other

Please list other services not listed above that you are seeking:*

Are you seeking training? If yes, please specify:*

Yes

Specify training you are seeking:

EDUCATION HISTORY

Are you Currently Enrolled in School? (if yes, where)*

High School Dropout

High School Diploma/GED

Some College

Associates degree or higher

Highest Level of Education:*

Yes

School Attending:*

Certificates / Licenses / Degrees Attained

Type:*

Certification

License

Associates

Bachelors

Masters

Doctorate

Title of Program:*

Issuing School/Organization:*

Issuing Country:*

Issuing State*

Completion Date:*

Expiration Date (If Applicable)

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

Yes

BASIC SKILLS / EDUCATION FACTORS

Is English your primary language spoken at home? *

Yes

What is your primary language spoken at home?*

Do you require interpretation services?*

Yes

Are you currently enrolled in Adult Basic Education Courses? (IE: GED or Literacy Classes)*

Yes

WORK READINESS

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

Yes

Dependent Care Needs *

Childcare

Special Needs Child

Adult Care

Outline your transportation situation below:

Driver’s License (Check all that apply)*

Has a Valid License

Does not have a License

Suspended

Restrictions

DUI

Driver’s License Endorsements (Check all that apply)*

No Endorsements

Air Brakes Restriction

Class A except bus Restriction

Tankers/Tank Vehicles

Class A except tractor/trailer rest

Double and triple trailers

Hazardous Materials

Passenger Vehicles

Combination Hazardous Materials/Tanker Vehicles

School Bus

Automobile (Check all that apply)*

Owns Automobile

Auto needs repair

Lack automobile insurance

Cannot afford gasoline

Automobile impounded

Automobile repossessed

Access to dependable automobile

Access to public transportation

Relies on public transportation

Please give details about your access to telephone communication: (Check all that apply)*

Telephone(Inside my home)

Access to Telephone(Neighbor/Other)

Cell Phone

Adequate Contact Person(s)

Do you have a professional voicemail?*

Yes

Please give details about Work Attire Needs (Check all that apply)*

Uniforms

Interviewing Clothes

Needs work tools/Equipment

Are there other factors preventing you from gaining employment? If yes, please specify:*

Yes

Factors preventing from gaining Employment*

Obsolete Skills

License Expired/Revoked

Union Dues in Arrears

Other (Explain below)

Other factors gaining emplyment*

Do you need any special accommodations to work? If yes, please specify:*

Yes

Specify accommodations*

EMPLOYMENT /JOB SEARCH

Do you have a resume?*

Yes

Do you target your resume for each job applied for?*

Yes

Do you have an elevator speech?*

Yes

Are you comfortable using: (Check all that apply)*

Online Job Boards

Illinois Job Link

Other Social Media Job Search Sites (list):

List Other Social Media Job Sites*

Are you proficient in the following computer programs: (Check all that apply)

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft PowerPoint

Are you interested in Self-Employment?*

Yes

Do you participate in volunteer opportunities?*

Yes

OCUPATIONAL TRANSFERRABLE SKILLS

Please check all skills that you feel you possess*

Communicate Visually or Verbally

Consult with customers concerning needs

Maintain records, reports, or files

Maintain Relationships with clients

Make Decisions

Move or lift heavy objects

Obtain information from Individuals

Oversee execution of organizational or program policies

Plan or organize work

Prepare reports for management

Provide Customer Service

Understand second language

Use computers to enter, access or retrieve data

Use health or sanitation standards

Use interpersonal communication techniques

Use oral or written communication techniques

Use project management techniques

Use secretarial procedures

Use time management techniques

Work as a team member

Please list any additional skills that are not included above:

List transferrable technical skills from previous job(s), If applicable

Describe skills needed for the position that you are targeting (if known):

LIVING ENVIRONMENT (Optional)

What is your current housing situation? (Check all that apply)*

Owns/Rents

Homeless

Residing in Shelter

Facing possible eviction

Needs Energy Assistance

Resides in Public Housing

At Risk of becoming Homeless

Substandard Living Conditions

Are concerned about being able to pay monthly rent or mortgage for your housing within the next six months? If yes, please explain*

Yes

Explain about the payment of monthly rent or mortgage for your housing within the next six months*

Do you feel safe, stable, and secure in your home environment? If no, please explain*

Yes

Explain about your safety at home*

PERSONAL/FINANCIAL (Optional)

Do you have any Financial issues or concerns? If yes, please describe.

Yes

Explain about you financial issues or concerns*

Have you ever applied for or received public assistance? If yes, please Specify:

Temporary Assistance for Needy Families (TANF)

Food Stamps (SNAP)

Housing

Social Security Disability Insurance (SSDI)

Supplemental Security Income (SSI)

Foster Care

Medicaid

Other

Other received public assistance

ADDITIONAL: Please expand on or add anything that you feel is important for your career advisor to know about you and your current circumstances:

OAS Paper Customer Questionnaire