2. Please disregard the sign-in prompt above.
4. Do you need additional help or resources for your job search? Please complete and submit the form below and our Employment Resource Navigator will assist you.
6. First Name*
8. Last Name*
10. Age*

    1. 17-24
    2. 25 or older
12. Phone*
14. Email Address*
16. Military Veteran or Spouse?*
    -- Select One --YesNo
18. Zip Code*
20. How would you like to be contacted? *
    -- Select One --PhoneEmail

    You must provide a phone number or email address in order for staff to respond to your inquiry
22. Would you be interested in meeting on a virtual platform (based on availability)?

    1. Yes
    2. No
24. Have you visited the Loudoun Workforce Resource Center before*
    -- Select One --YesNo
26. If "Yes" to above, what services did you seek or receive?*

    1. Resume help
    2. Met with an Employment Counselor
    3. Attended a workshop
    4. Attended an employer event
    5. Other
    6. I'm not sure
    7. Not applicable
28. How did you hear about the Workforce Resource Center?*
    -- Select One --Community PartnerDept. of Family Service StaffFriend/RelativeSelf-Referral WebsiteOther - please list below
30. Other - list here
32. Have you received services from any of the following in the last 6 months? (check all that apply)*

    1. Catholic Charities
    2. Crossroads Jobs
    3. Department of Aging & Rehabilitative Services (DARS)
    4. Loudoun Literacy
    5. Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI)
    6. Ticket to Work
    7. Virginia Initiative for Education and Work (VIEW)
    8. Virginia Employment Commission/Unemployment Insurance
    9. Other - not listed
    10. Not applicable
34. Are you currently working?*

    1. Yes
    2. No
35. If yes - please select below*

    1. Full-time
    2. Part-time
    3. N/A
37. If you are currently employed, what industry do you work in and your job title
39. What information or resources do you need?
    Select all that apply
41. Resume Help

    1. I do not have a resume and I need help writing one
    2. I want to have my current resume reviewed
43. If you selected resume review above, you can upload your resume here
45. Employment Obstacles

    1. Sometimes my background (criminal) prevents me from getting or keeping a job
    2. I have a disability and need accommodations for work
    3. I need transportation to get to work
    4. I am in need of childcare so I can work
    5. I want to improve my English language
47. Workforce Training

    1. I want to learn about training programs in the area
    2. I want to see if I am qualified for training funds
49. Job Search

    1. I don't know how to start my job search
    2. I have skills, but I'm not sure what I am qualified to do
    3. I want to switch careers, how can I do that
    4. I need help to prepare for interviews
51. Need something that is not listed? Tell us how we can help.
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field