WORKSOURCE GEORGIA MOUNTAINS SCREENING

WIOA PRE-SCREENING TOOL

ATTENTION: WorkSource ADULT and DW funding are on pause. If you'd like to proceed with the survey, please do. Once funding is open, staff will contact you. We apologize for the inconvenience. Feel free to contact our office at 770.538.2727.

1. Applicant Information *This question is required.

First Name

Last Name

Street Address

City

State

Zip

Email Address

Phone Number (123-456-7890)

2. Age: *This question is required.

4. You must be a resident or laid off from one of the counties listed. If you were laid off, you would choose the County from which you were laid off. If you were not laid off and do not see your county listed, call 770-538-2722 for assistance.

Example: you live in Gwinnett but were laid off in Hall; select Hall County below and proceed with the application. *This question is required.