Career Center Reg | Hempsteadworks

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516-485-5000 | TTY: 1-800-662-1220

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Career Center Registration

Please call 516-485-5000 with any questions regarding this form.

Anchor 1

Details

*=Required fields

Last Name:*

First Name:*

MI:

Application Date:

Do you need an interpreter?*

Yes

Preferred Language of Interpreter:

Date of Birth (MM/DD/YYYY):*

Gender:*

Are you registered for Selective Service?*

Yes

Not Applicable

NY Drivers License

Address:*

City:*

State:*

Zip:*

County*

Email:*

Yes, I would like to receive emails and /or text messages from Hempstead Works about Career Registration, free training, surveys and other programs. Message and data rates may apply. The frequency of the messages may vary. You can opt out at any time.

Cell Phone (XXX-XXX-XXXX):*

Home Phone (XXX-XXX-XXXX):*

Contact Preference:*

Are you a U.S. Citizen?*

Yes

If no, are you authorized to work in the US?

Yes

Ethnicity / Race

Note: The Ethnicity and Race questions are voluntary. Information is confidential and will only be used for record keeping and affirmative action requirements. You will not be penalized if you do not want to answer.

Race (Select all that apply):

Native American or Alaska Native

Asian

Native Hawaiian and Other Pacific Islander

Black or African American

Unknown

White

I do not want to disclose

HempsteadWorks Career Center

50 Clinton St.

Suite 400

Hempstead, NY 11550

Accessibility

TEL: 516-485-5000

TTY: 1-800-662-1220

The Workforce Innovation and Opportunity Act financially assisted program is an equal opportunity employer / program. Auxiliary aids and services are available upon request to individuals with disabilities. To request reasonable accommodation, please call our Disability Resources Coordinator at (516) 485-5000 ext. 1113.

A service of the Town of Hempstead/City of Long Beach Workforce Development Board

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