Intake Form - Main South Community Development Corporation

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Intake Form
Main South Community Development Corporation
Workforce Development Center
Name: ______________________________________
Date of Birth: _________/______/________________
Month (MM) / Day (DD) / Year (YYYY)
Address: ____________________________________
Street
Apt. #
____________________________________
City
State
____________________________________
Zip Code
Phone: (______)______________________________
Area Code
Please Indicate the Service you are seeking (check all that apply):
□ Resume Assistance
□ Job Placement
□ Basic Life Skills
□ Computer Skills
□ Cover Letter Assistance
Have you prepared a resume in the past?
□ Yes
□ No
If yes, do you have an existing resume?
□ Yes
□ No
Please indicate your level of computer skills:
□ None
□ Some
□ Proficient
In Addition to providing workforce assistance, the MSCDC can also provide
information regarding other services available in the community.
Are you currently displaced from your residency?
□ Yes
□ No
Please indicate if you are in need of any service agency assistance (check all that
apply):

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