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Career Center Registration


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?*

Are you a spouse of a US Armed forces member on active duty and lost your job as a direct result of relocation due to a permanent change in your spouse's duty station?


Are you a High School Dropout?


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?

Driver's License

Do you have a driver's license?


Type of License:


Do you need public transportation to get to a job?

Do you have reliable transportation to and from work?


3.  Are you a migrant or Seasonal Farm Worker?

If yes, check one of the following:

5.  Are you a Displaced Homemaker?

Have you been providing unpaid services to family members in the home and:

  • Depended on the income of another family member but are no longer supported by that income, or are the dependent spouse of a member of the military on active duty and whose family income is significantly reduced due to a deployment, a call or order to active duty, or the death or disability of the member, AND

  • Are unemployed or underemployed and are having trouble finding or keeping employment.

6.  Are you a single parent?

Are you a single, separated, divorced or widowed person who has primary responsibility for one or more dependent children under age 18 (including single pregnant women)?

7.  Are you homeless?

Do you lack a permanent and suitable nighttime residence?  This includes:

  • Sharing housing with other persons due to loss of housing, economic hardship or a similar reason

  • Living in a motel, hotel, trailer park or campground due to a lack of other suitable options

  • Living in an emergency or temporary shelter

  • Abandoned in a hospital

  • Awaiting foster care placement, or

  • Having a main nighttime residence that is a public or private place such as a car, park, abandoned building, bus or train station, airport or campground.

8.  Are you an ex-offender?

Were you subject to any stage of the criminal justice process?  Do you need help overcoming barriers to employment resulting from a record of arrest or conviction for crimes against persons or property, status offenses or other crimes.

9.  Are you an English Language Learner?

Do you have limited ability in speaking, reading, writing or understanding English?  Do you meet one of the following two conditions?

  • Is your native language a language other than English?

  • Do you live in a family or community where a language other than English is the main language?

10.  Do you think you have a cultural barrier?

Do you have attitudes, beliefs, customs or practices that may make it hard for you to find work?

11.  Do you lack basic skills?

Are you unable to solve problems, or read, write, or speak English at a level necessary to function on the job, in your family, or in society?

I hereby certify that all of the information provided by me on this form is correct, accurate and complete to the best of my knowledge. 

How did you hear about HempsteadWorks?


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 Maria Lombardi at (516) 485-5000 ext. 1113.

An error occurred. Please make sure you have filled out all the required fields. Please type "n/a" in a required  box if it does not apply to you.

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Do you have an occupational certificate or license?*

Add another Certificate/License


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