» Workforce Innovation and Opportunity Act (WIOA)

Need funding to pay for college or training? The Workforce Innovation and Opportunity Act (WIOA) can help!

WIOA Programs

Adult (ages 18+): Designed to assist economically disadvantaged adults, who are underemployed.
Dislocated Worker: Serves customers who have been separated from employment due to lay-off, business closure, or displaced homemakers.
Youth (ages 16-24): Designed to help low-income youth and young adults with additional barriers achieve educational and employment goals.

WIOA Program Requirements

Monthly attendance
Monthly check-in with your career advisor
Course syllabus each semester

Workforce Innovation and Opportunity Act (WIOA)

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Demographic Information

Social Security Number

Date of Birth

MM slash DD slash YYYY

Gender

Male

Female

MALES ONLY - Registered for Selective Services

Yes

Documented Exemption

N/A

Citizenship Status

Citizen of the U.S.

Alien/Refugee Lawfully Admitted to U.S.

U.S. Permanent Resident

Are you Disabled?

Yes

Are you Homless?

Yes

Military Status

Veteran

Non-veteran

Employment Information

Most Recent Employer

Salary

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Occupation Title

Untitled

Employed

Employed, but received notice of termination of employment or military separation

Fired

Quit

Layoff

Not employed

Receiving Unemployment Benefits

Exhausted benefits

Not receiving benefits

Other

If other, explain

Education

High School Diploma

General Educational Diploma (GED)

Neither

If neither, highest grade level completed

Degree/Vocational or Technical Certification Earned

Year

Income

Are you Receiving Public Assistance Services?

Yes

If so, specify

Supplemental Nutrition Assistance Program (SNAP)

Public Housing

Supplemental Security Income (SSI)

Temporary Assistance for Needy Families (TANF)

Social Security Disability Insurance (SSDI)

Household income during past 6 months

Number of dependent members in the household including yourself

Prior Enrollment in the WIOA Program?

Yes

If yes, Date

MM slash DD slash YYYY

Training Program/Curriculum Seeking

Currently enrolled in college?

Yes

If yes, where?

WIOA Interview Questions

Number of Family/Household? How many adults? How many Children (ages)? Do your children live in or out of the home?

Marital Status

How long?

If you have a spouse; are they supportive of your desire to be retrained and/or seek employment? Explain.

Did you graduate high school or complete your GED?

Yes

What year and what school did your receive either?

Have you taken any college courses? If so please list the schools, classes and/or programs you attended or completed.

Current/Last Employer:

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Job Title

Duties

Rate of Pay

Pay Type

Supervisor Name

Supervisor Phone

Explain reason no longer working there anymore

Previous Employer:

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Job Title

Duties

Rate of Pay

Pay Type

Supervisor Name

Supervisor Phone

Explain reason no longer working there anymore

Tell me what you liked most and least about any of your last few jobs

What has been your hardest job? Why?

What is your biggest career accomplishment? (You can list more than one.)

Are you drawing Unemployment Insurance (UI)? If so, what is your weekly amount?

List 3 Strengths

List 3 Weaknesses

List anything you consider a barrier for yourself. Is there anything that could prevent you from participating in and completing our program and/or in finding a job? If so, please explain.

What is your career goal?

If you are seeking training, what job are you seeking upon completion of training? Why are you interested in this type of employment?

What are your financial plans for living expenses? How do you plan to support yourself while you are enrolled in our program if you are approved for training?

Do you have a driver’s license? Do you have a car to drive or some reliable form of transportation? If not; list 3 possible ways you could find transportation to/from appointments.

Describe a recent success you had - it can be a big or small success. You can tell me about solving a problem, moving to a new place, starting school, something you made or a success you can think of. List 3 things you did to make this success happen.

One area of my life I have decided to take control of is:

I will demonstrate this by:

I will ask [Insert person] to support me by:

Who has had the most positive impact on your life and why?

Do you have any pending legal situations currently taking place? If yes; please explain.

Are you currently working with any other community agencies or enrolled in any other programs? If yes, list and describe the programs you are involved in and the services you are receiving.

How long have you lived at your current address? If you have moved within the last 2 years from where and why?

Please write 2 paragraphs explaining your current situation and explain why you are seeking assistance from WIOA and what you hope WIOA can help you accomplish.

Disclaimer & Signature

My signature below indicates that I understand the information contained in this form. I certify under penalty of perjury that all the above information is true and complete. I agree that any information I have supplied is subject to verification.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

Workforce Innovation and Opportunity Act (WIOA)

WIOA Programs

WIOA Program Requirements

Workforce Innovation and Opportunity Act (WIOA)

Demographic Information

Employment Information

Education

Income

WIOA Interview Questions

Disclaimer & Signature

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