Contact Form

Thank you for your interest in the American Job Center (AJC) services. Please complete this form and you will be contacted by AJC Outreach staff and receive regular updates from the American Job Centers and Capital Workforce Partners.

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* 1. Contact Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. What City/Town Do You Live In?

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* 3. Employment Status

Employed

Unemployed – Receiving Unemployment Compensation

Unemployed – NOT Receiving Unemployment Compensation

Employed – Part Time

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* 4. Are you interested in Information Technology? If so, select area of interest.

Web/Software Development

Computer Network Support

Computer User Support

Data Analytics/Database Administration

Cyber-security

Other (please specify)

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* 5. Are you interested in Healthcare? Is so, please select area of interest.

Medical Billing and Coding

Medical Assistant

Medical Office Admin

Certified Nurse Aide

Pharmacy Technician

Sterile Processing

Other (please specify)

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* 6. Other Fields of Interest

Manufacturing

Construction

Transportation/Logistics

Finance/Insurance

Retail

Food Service

Education

Social/Human Services

Other (please specify)

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* 7. How did you hear about us?

Attached to my UI status/ UI Orientation

Session or phone call from the local American Job Center

Poster in the community

CTHires

Capital Workforce Partners website

Social Media

Email Blast

Other (please specify)