JobLink Interest Survey and Contact Form

Question Title

* 1. Your Information

First Name (legal name on your birth certificate)

Last Name (legal name on your birth certificate)

Preferred Name

Phone Number

Email Address

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* 2. How do you prefer we contact you?
(select the method you check most often)

Text

Phone Call

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* 3. Do you live and/or go to school in Tompkins County?

Yes, I live, work, or attend/will attend school in Tompkins County.

No (you may still complete this form).

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* 4. If you live outside of Tompkins County, do any of the following apply to you?

I can get help with transportation or carpool to Tompkins County

A close family member or partner lives in Tompkins County who I visit often

I am planning to move to Tompkins County

None of the above

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* 5. Please tell us your age and school status as of today?

I am ages 14-21 and I am in school (includes middle school, high school, BOCES, or college).

I am ages 16-24 and I do not attend school OR will be graduating before February 1, 2023.

Neither of these are true of me. If you submit this form, our staff will refer you to another program and services if you are 25.

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* 6. Are you experiencing any of the following?
(Please note that your answers will not be shared with anyone outside of JobLink staff)

I left high school before graduating / dropped out.

I am 17 years old or younger, but I have not attended school in the last 45 days (not counting school breaks).

I am pregnant or parenting (including non-custodial parents).

I have a disability or have/had an IEP in school. Please note that disabilities include physical, learning, speech, developmental, cognitive, chronic illness, and mental health.

I am currently or have been in foster care.

I am experiencing housing insecurity or homelessness. For example, I am staying on someone's couch or not sure where I will sleep some nights.

I have run away from home.

I have been involved with the juvenile or adult justice system.

I am an English language learner.

None of these situation apply to me.

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* 7. Please tell us about your household

My parent or legal guardian is currently incarcerated.

In the last 6 months, myself or my household has received SNAP (food stamps), SSI, TANF, HEAP, or Medicaid.

I and/or my household has no income.

I am not sure if these situations apply to me.

None of these apply to me.

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* 8. Please tell us about your employment history

I have never had a paid job.

I have been "let go" or fired from a job in the last 12 months (1 year).

I have never held a full-time (30 hr/week) job for more than 13 weeks (4 months) in a row.

I currently have a paid job.

I have had a paid job in the last 12 months (1 year), but I don't know the dates/details.

Other (please specify)

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* 9. Are you interested in any of the following opportunities?

Tutoring, study skills, rejoining school after dropping out, attaining a high school diploma/equivalent

Paid employment

Internships, job shadowing, apprenticeships (unpaid)

Group trainings and workshops with other teens and young adults

Leadership opportunities

Resume, cover letter, portfolio assistance

Financial literacy education (banking, saving money, taxes)

Job interview practice

Information about the local labor market and in-demand jobs

Entrepreneurship opportunities (starting and operating your own small business)

Assistance with transportation, childcare, housing, mental health referrals, legal aid, work clothes or uniforms including footwear, paying for books or school supplies

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* 10. From the list below, which kind of job(s) are of interest to you? (Options are based on current JobLink worksite openings as of January 2023)

Retail and/or cashiering

Trades/construction and/or working with my hands

Farming and agriculture

Recreation and/or camp counseling

Food service

Maintenance and/or cleaning

Elder care

Library services

Other (please specify)

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* 11. How did you hear about JobLink

Family member

Teacher, professor or school guidance counselor

Friend participating in JobLink

Caseworker or therapist

Facebook or Instagram post

Department of Labor worker at Center Ithaca

Other (please specify)

JobLink Interest Survey and Contact Form

Question Title

* 1. Your Information

Question Title

* 2. How do you prefer we contact you?(select the method you check most often)

Question Title

* 3. Do you live and/or go to school in Tompkins County?

Question Title

* 4. If you live outside of Tompkins County, do any of the following apply to you?

Question Title

* 5. Please tell us your age and school status as of today?

Question Title

* 6. Are you experiencing any of the following?(Please note that your answers will not be shared with anyone outside of JobLink staff)

Question Title

* 7. Please tell us about your household

Question Title

* 8. Please tell us about your employment history

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* 9. Are you interested in any of the following opportunities?

Question Title

* 10. From the list below, which kind of job(s) are of interest to you? (Options are based on current JobLink worksite openings as of January 2023)

Question Title

* 11. How did you hear about JobLink

Question Title

* 12. Do you have any questions for staff?

* 2. How do you prefer we contact you?
(select the method you check most often)

* 6. Are you experiencing any of the following?
(Please note that your answers will not be shared with anyone outside of JobLink staff)