Employment Services Application | Urban League of Greater Madison

Application for free career development services

Thanks for your interest in the Urban League of Greater Madison. We offer a broad array of career assessment, training, coaching and placements services tailored to high demand industries and occupations. We also offer strong connections to employers through our preferred network of business partners. Please complete the brief application below to get started. Once we receive your application, one of our professional career specialists will contact you to schedule an individual meeting to discuss your career goals.?

If you have any questions or problems completing this application, please do not hesitate to contact us at (608) 729-1200.?

Please note that all information collected here will be kept strictly confidential.?

Workforce Program Application

Step 1 of 4

About You
The following applications consists of four sections that will allow us to create a career plan that is individualized to YOUR needs. There is NO COST for Urban League career services. Your information will be kept confidential. Sections include: 1. Employment & Education Survey 2. Demographic Information 3. Membership Commitments 4. Disclosure Statements
First Name*
Last Name*
Mobile Phone
Other Phone
Email
Address
Street Address Address Line 2 City State ZIP Code
How did you hear about us? (mark all that apply)
- Email
- Facebook
- Family or Friend
- FSET/Foodshare
- Information Session
- United Way 211
- Job Center
- Online
- Urban League Employee
- Urban League Website
- W2
- Walk In
- Other community service agency
- Other
Employment & Education Survey
The following information will help us create a comprehensive career plan individualized to YOUR needs. The information you provide here will be kept strictly confidential.
Has your employment situation been impacted by the COVID-19 pandemic?
- I have been furloughed due to the pandemic
- My work hours have been reduced due to the pandemic
- I have been laid off due to the pandemic
- I had a job offer delayed or rescinded due to the pandemic
- Other
- The pandemic has NOT impacted my employment situation
Highest Level of Education Completed*
Do you have any certifications? (I.e. CNA, MA, OSHA, etc.)
Field of interest
- I am open to any available positions
- Administrative/clerical/office
- Construction or skilled trades
- Custodial or housekeeping
- Customer service
- Food service
- Grocery or retail
- Healthcare
- Insurance
- K-12 Education
- Warehouse/industrial/production
- Other
What Shifts Are You Available To Work (all that apply)
- 1st shift (work hours from approximately 9 am to 5 pm)
- 2nd shift (work hours from approximately 5 pm to 1 pm)
- 3rd shift (work hours from approximately 12 am to 8 am)
- Weekdays
- Weekends
Do you have any disabilities or physical limitations that would prevent you from performing specific job duties?
- No
- Yes
Tell us about your technology capabilities (mark all that apply)
- I have a computer
- I have a tablet or smartphone
- I have high speed Internet Access
- I have slow or unreliable Internet access
- I have no Internet access
Current Employment Status*
- Not Employed
- Employed (full or part-time)
Current Employment Type
- Full Time
- Part Time (one job)
- Part Time (multiple jobs)
List your current employer(s)*
Employer Name Hourly Wage
Do you receive health insurance from your employer?*
- Yes
- No
When were you last employed*
- Less than 30 days ago
- More than 30 days and less than 6 months
- More than 6 months ago
Who was your last employer
What was your hourly wage*
Tell us about your transportation situation (check all that apply)
- I have a valid drivers license
- I do not have a valid drivers license
- I have access to a vehicle or reliable transportation
- I need a job that is on a bus line
Do you have any of the following concerns related to your employment history?
- Limited work history or experience
- Criminal record
- Need for additional training or certification
- Gaps in your work history
- Short duration of jobs/multiple jobs in a short period of time
- Recent termination
- Lack of references or concerns about references
- Other
Do you need support with any of the following? (check all that apply)
- Childcare
- Child support
- Domestic violence or safety
- Drug or alcohol use
- Food or other basic needs
- Healthcare or health concerns
- Housing or living situation
- Legal history
- Transportation
- Other
Do you currently receive any Economic Assistance benefits (check all that apply)
- None
- Cildcare Assistance (Wisconsin Shares, City of Madison, etc.)
- Foodshare
- Healthcare/Badgercare
- Housing Assistance
- W2
- Other
Upload Resume (optional)
Accepted file types: doc, docx, pdf, Max. file size: 256 MB.
You may optionally share your resume with us so we can better help you meet your career goals. We can also offer advice to help strengthen your resume as part of our free services.

Application for free career development services

Workforce Program Application

Step 1 of 4

About You

Employment & Education Survey

Demographic Information

Membership Commitments

Release of Information

You have Successfully Subscribed!

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Employer Name	Hourly Wage