ManTraCon Corporation New Building

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Man-Tra-Con — 100 Initial Intake Form

WIOA Title 1B: Adult, Dislocated Worker, Youth Services

Find out if you are eligible to receive Man-Tra-Con Job Seeker services by completing and submitting the form below. After submitting the form, a career specialist will contact you for more information. This is the FIRST STEP before being determined eligible to receive assistance with your job search or training goals.

PLEASE NOTE: This is NOT A JOB APPLICATION! This is a PRELIMINARY APPLICATION to determine if you are eligible to receive our services. Please complete and submit the form below:


Legal Name:(Required)
DATE of BIRTH:(Required)
Have you received services from us, visited the resource room, or completed our online interest form?(Required)
Are you a Veteran?(Required)
Are you homeless or at risk of becoming homeless?(Required)
(MALES ONLY) If age 18 or older, have you signed up for Selective Service?
(FEMALES ONLY) Has your last name changed due to marriage or divorce?
Do you now or have you ever received unemployment benefits?(Required)
Do you or any member of your household receive SNAP benefits?(Required)
Have you earned a certificate or degree?(Required)
Are you enrolled in college or have a schedule for an upcoming semester?(Required)
Are you interested in training?(Required)
How would you like to continue our enrollment process?(Required)
How did you hear about us?(Required)

Did someone help you complete this form?(Required)
Services of Interest (Check all that apply):(Required)
This field is for validation purposes and should be left unchanged.

Proud partner of the American Job Center network