Customer Interest Form

	First Name:			Last Name:
	Address:			City:
	State:			Zip:
	Phone:			E-mail Address (optional):
	Comments:			Referred By:
	Current Employment Status:

	Services Interested:
	Core Services Include:
	Resume Preparation   Job Search Assistance   Career Counseling   Supportive Services   Labor Market Information   Job Placement Assistance
	Intensive Services Include:
	Skill Assessments   Job Clubs   Pre-vocational Services   Education and Occupational Skills Referrals
	Training Services Include:
	Occupational Skills Training   On-the-Job Training (OJT)   Skills Upgrade and Retraining   Entrepreneurial Training   Job Readiness Training   Adult Education and Literacy Activities   Employer Customized Training

Auglaize County Workforce Investment Act 801 Middle Street Wapakoneta, Ohio 45895 (419) 739-7225 Site Design By: CORPCOMM GROUP, Inc.