[Pinal County] Job Seeker Interest Form

All information and records you provide will be treated as confidential to the extent permitted by law.

Phone Number

Have you or your spouse ever served in the Armed Forces?

Yes

Have you worked in agriculture in the last 24 months?

Yes

What city or town do you live in?

Have you recently been laid off?

Yes

If yes, please provide the name of your last employer?

I would like more information regarding? Check all that apply.

Job Search Assistance

GED Preparation/ English Acquisition Classes

Preparing for Interview

Job Skills Development

Build your Resume or Cover Letter

Other

If other please specify:

Choose the best method to contact you

Phone Call

Text

All Options

Equal Opportunity Employer / Program • Auxiliary aids and services are available upon request to individuals with disabilities. Certain accommodations require 48 hour notice. To request this document in an alternative format or for further information about the ARIZONA@WORK Pinal County Equal Opportunity and Affirmative Action policy, please call 520-866-6227.

For Steven’s Amendment Information, please visit http://pinal.gov/StevensAmendment