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Veterans' Supplemental Registration

As a veteran, you may be eligible for additional services. Please take a moment to fill out the below supplemental registration form only if you have served for at least 181 days of active duty in the United States military. The information will be forwarded to a veterans' representative and will help us provide you with more targeted assistance.

Please fill out this form only if you are requesting additional assistance.

You will need to register with Connecting Colorado prior to filling out this form.

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Dates of Service

Do you have a disablity?

                    

 If service connected, rated

: (Mark all that apply)

More education    Computer Skills    Job search methods   Childcare

Self-marketing     Interviewing skill help        Resume help

Help converting my military skills to civilian skills   Federal job application help

(Mark all that apply)

Physical disability      Health problems     Substance abuse

Discrimination (age, race, gender, etc.)          Lack of computer skills

No tools      No driver's license         Lack of work experience

Felony conviction     Mental health issues        Lack of civilian work experience

Lack of transportation     Lack of job skills        Lack of certification or license

If any of the following categories apply, you :
(Mark all that apply)

Self-employed      Laid-off due to no fault of your own        Low income

Unlikely to return to previous occupation    Laid-off due to facility closure

Homeless        Food stamp recipient      Long-term unemployed   

Ex-offender

Please list your employment goals or desires:

What is the lowest starting pay you are willing to work for?   

$ per

 

 

 

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Laramie Building • 3500 Illinois Street  Golden, CO 80401 • 303-271-4700 • 800-659-3656 TTY|TDD • Contact Us  

Jefferson County Workforce Center is an equal opportunity program; auxiliary services are available upon request to individuals with disabilities.

 

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