Career Center Registration

If other than English, do you need an interpreter?


If you are a male born after Dec. 31, 1959, are you registered with the U.S. Military Selective Service?

New York State Driver's License Number or NYS Non-Driver License ID Number*

Or other verification of date of birth using acceptable source document


Are you a U.S. Citizen?

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

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)



Note: IEP Diploma/Disabled with Certification disclosure is voluntary.  You will not be penalized for nondisclosure of IEP Diploma/Disabled with certification of attendance/completion


If College, check all that apply

Are you attending a secondary, post-secondary, vocational, technical or academic school full-time?*

Are you between terms, do you intend to return to school?


Are you currently employed?*


Have you applied for unemployment?

Are you currently claiming Unemployment Insurance Benefits?


Note: Veterans and "eligible spouses" receive priority of service.

Did you serve in the United States Armed Forces?*

Are you an eligible spouse of a veteran?*

Employment Preferences

Check your work preferences

Minimum acceptable wage required.

Which shift(s) are you willing to work?  Check all that apply.

Are you a Migrant or Seasonal Farm Worker? * (for definitions please see staff or Supplemental Questionnaire)

Acceptable Job Locations

I am willing to work within the following zip code, county or state* (check the number of miles and write the zip code)

Employment Objective

List most recent occupation(s)/job(s)


Work History

If you have job experience, please put as much detail in this section as possible to improve our chances of helping you find work.  Enter the most recent employment first. Complete all required items for each employer.

Work History 1

Trade Adjustment Assistance (TAA)

Have you been notified by the New York State Department of Labor (received Form TA722) that you are eligible for Trade Adjustment Assistance?

If No, were you separated from your employment due to foreign trade?

Driver's License

Do you have a driver's license?

What type of license do you have?


Do you need public transportation to get to a job?

Do you have reliable transportation to and from work?


Do you have an occupational certificate or license?*



Do you have a college degree, diploma, or educational certificate?*

Job Skills and Qualifications

List at least 1*


Include skills and abilities that you used in your job(s), volunteer work, personal experiences or that you have acquired through school or training.  Examples: laboratory techniques, carpentry, welding, ability to read blueprints, typing, and computer skills such as word processing software, programming languages, or computer assisted design.  Also, include languages in which you are fluent.

Job Search / Training Assistance

Have you previously registered with HempsteadWorks?

HempsteadWorks Career Center

50 Clinton St.

Suite 400

Hempstead, NY 11550

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.

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