Job Placement Reporting for Career Source Members

Report your success to help other jobseekers

Are you a Career Source member? Have you found a job? If so, congratulations! As mentioned in our orientation, some of our funding comes from federal and state sources that require us to report general job placement information. So that we can continue to receive funding to provide services to job seekers, please take a moment to complete our job placement form:

* indicates a required field.

Your Information
*First Name
*Last Name
Address
*City
State
Zip Code
Telephone
*E-Mail Address
Employer Information
*Employer Name
Address
*City
State
Zip Code
Job Information
*Job Title
*Job Start Date
Pay Rate	Per: HourDayWeekMonthYear
*Were medical benefits offered?	Yes  No
Expected Duration	More Than 150 Days 150 Days or Less
*Full Time?	Yes  No
*Hours/Week
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