Name *

First Name

Last Name

Phone *

(###)

###

####

Are you an ANDLRC participant? *

Yes

No

Have you been previously employed? *

Yes

No

What is your current employment status? *

Check all that apply

Unemployed

Employed

Underemployed

Going back to college

Self-Employed/Entrepreneur

What are you seeking to gain from this event? *

Check all that apply

Resume building

Interview skills

Cover Letter writing

Reference selection

Ability to raise my salary

Will you be interested in following up with our Career Coach after this event? *

Yes

No

I hereby grant KOINONIA COMMUNITY SOLUTIONS permission to use my likeness from this event in any and all of its future publications, including website entries, or promotional materials without payment or any other consideration. *

I Agree