Transitioning Military & Veteran Workforce Development Intake Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: Password must contain the following: 12 Characters 1 Uppercase letter 1 Lowercase letter 1 Number 1 Special character Page 1 - General Information Select the workshop location you would like to attendPlease select... Cape Cod, MA Detroit, MI Downey, CA Escondido, CA Grand Rapids, MI Hampton Roads, VA Huntington Beach, CA Indianapolis, IN Kansas City, MO Los Angeles, CA Mangilao, Guam Manhattan, KS Mission Valley, CA Oceanside, CA Online Quantico, VA Sacramento, CA San Diego, CA San Francisco, CA Sedalia, MO USS Midway, CA Virginia Beach, VA Washington, DC Select a programPlease select... Industry Networking Seminar In-Person – REBOOT Lite In-Person – REBOOT Workshop In-Person – REBOOT Your Life In-Person – STARR Seminar Online – REBOOT Workshop Online – REBOOT Your Life Online – STARR Seminar Operation Skillbridge Please select the preferred industry you are interested inPlease select... Aerospace Automotive Business Services Cleantech Construction Defense Education Financial Services Government Healthcare Hospitality Food Services Information Technology Life Sciences Manufacturing Medical Devices Non-Profit Public Utilities Retail Services Security Shipbuilding Software Telcom Transportation Travel/Tourism Is there a company that you are interested in working for? Personal Information Last 4 Digits of Social Security # First Name Last Name Current Street Address City State/Province/RegionPlease select... AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code Are you moving after your military service? Yes Preferred Street Address Preferred City Preferred StatePlease select... AK AL AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Preferred Zip Code Phone Number Alternate Phone Email Address non-military email address Date of Birth Age GenderPlease select... Male Female Other EthnicityPlease select... American Indian or Alaskan Native Black or African American Hispanic or Latino Asian Filipino Native Hawaiian or Pacific Islander White Other Highest Level of EducationPlease select... High School GED Some College 2 Year's Associates Degree 4 Year College Degree Advanced Degree Vocational/Trade School Area of StudyPlease select... Arts Business/Economics/Accounting Computer Science/IT Engineering Humanities/Language Law Life Science Medicine Physical Science Social Science Vocational Skill What are Training have you completed? Please select... ASP.NET C# Excel Java mySQL Oracle SQL Server Sybase Teradata Any other relational database(to select more that 1 option hold down the control button) Please Rate your experience of the following on a scale of 1 to 5:1 - No Knowledge2 - Beginner3 - Basic4 - Intermediate5 - Advanced 1 2 3 4 5 ASP.NET C# Excel Java mySQL Oracle SQL Server Sybase Teradata Any other relational database Living Situation Are you Homeless?Yes Are you at Risk of Homelessness?Yes Are you at living in subsidized housing?Yes Family Information Family SizePlease select... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Annualized Family Income Total household Gross wages and salaries before deductions. Emergency Contact Information Emergency Contact Name Emergency Contact Relationship Emergency Contact Phone Number Emergency Contact Email Address Referral Information Referral Name Referral Company Referral Phone Number Referral Email Address Page 2 - Military Information Military Service Enlistment Status Please select... Active Veteran Reserves Spouse Civilian Branch of ServicePlease select... Air Force Air National Guard Army Army National Guard Coast Guard Marine Corps National Guard Navy Space Force Most Recent Military RankPlease select... E-1 E-2 E-3 E-4 E-5 E-6 E-7 E-8 E-9 O-1 O-2 O-3 O-4 O-5 O-6 O-7 O-8 O-9 O-10 W-1 W-2 W-3 W-4 W-5 Military Occupation Special Ops Unit (Green Berets, Navy Seals, etc)? Enlistment Date Separation Date (If still on active duty, enter expected separation date) Reason for SeparationPlease select... Admin Separation End of Obligated Service Enlisted Retention Board High Year Tenure Medical Separation Perform to Serve Retirement Voluntary Separation Other Disabled VeteranPlease select... Not Disabled 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Wounded Warrior?Yes Do you have any special or accessibility needs?Please select... Amputee Blind Burn Hearing Impairment Orthopedic SCI Service Animal SFW/GSW TBI Visual Impairment Wheelchair None Spouse of a Service MemberYes Spouse's Full Name Command Information Command Name Command City Command StatePlease select... Alabama Alaska Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Command Phone Number Command Email War Served Select if you served in the following warAfghanistan (10/2001-12/2014) Select if you served in the following warIraq (3/2003-12/2011) Select if you served in the following warPersian Gulf (8/1990-2/1991) Select if you served in the following warVietnam (1/1959-4/1975) Select if you served in the following warKorea (6/1950-7/1953) Select if you served in the following warWorld War II (12/1941-8/1946) Employment Information If you are not employed, please answer the following questions: Are you currently unemployed?Yes When is or was your Last date of most recent employment (start of unemployment) Are you collecting unemployment?Yes Are you open to Relocating anywhere in the US?Yes Page 3 - Workshop Pre-Survey The following questions are part of a pre-REBOOT workshop survey. Your responses will have no bearing on your application to attend a workshop. We collect this information to evaluate the REBOOT workshop and the data can help us obtain more funding so that additional veterans can attend. Please answer all questions. For each statement below, please read carefully and indicate how much confidence you have that you could accomplish each of these tasks or beliefs by marking your answer according to the following 5-point scale. 1 = No Confidence2 = Very Little Confidence3 = Moderate Confidence4 = Confidence5 = Complete Confidence 1. Make a career decision and then not worry about whether it was right or wrong.Please select... 1 2 3 4 5 2. Find information about companies who employ people with my background and skill set. Please select... 1 2 3 4 5 3. Prepare a good resume.Please select... 1 2 3 4 5 4. Change occupations if you are not satisfied with the one you enter.Please select... 1 2 3 4 5 5. Choose a career in which most workers are the opposite sex.Please select... 1 2 3 4 5 6. Identify some reasonable career alternatives if you are unable to get your first choice.Please select... 1 2 3 4 5 7. Figure out what you are and are not ready to sacrifice to achieve your career goals.Please select... 1 2 3 4 5 8. Determine what your ideal job would be.Please select... 1 2 3 4 5 9. Describe the job duties of the career you would like to pursue.Please select... 1 2 3 4 5 10. Successfully manage the job interview process.Please select... 1 2 3 4 5 11. Find information about occupations you are interested in.Please select... 1 2 3 4 5 12. Find out the employment trends for an occupation.Please select... 1 2 3 4 5 13. Move to another city to get the kind of job you really would like.Please select... 1 2 3 4 5 14. Decide what you value most in an occupation.Please select... 1 2 3 4 5 15. Persistently work at your career goal even when you get frustrated.Please select... 1 2 3 4 5 16. Choose a career that will fit your preferred lifestyle.Please select... 1 2 3 4 5 17. Identify employers, firms, institutions relevant to your career possibilities.Please select... 1 2 3 4 5 18. Resist attempts of family or friends to push you into a career you believe is beyond your abilities. Please select... 1 2 3 4 5 19. Determine the steps you need to take to successfully complete your chosen career goal.Please select... 1 2 3 4 5 20. List several occupations in which you are interested.Please select... 1 2 3 4 5 21. Choose a career that will suit your abilities.Please select... 1 2 3 4 5 22. Choose a career that will suit your interests.Please select... 1 2 3 4 5 23. Get involved in a work experience relevant to your future goals.Please select... 1 2 3 4 5 24. Find out about the average yearly earnings of people in an occupation.Please select... 1 2 3 4 5 25. Talk with a person already employed in the field you are interested in.Please select... 1 2 3 4 5 26. I can communicate my strengths to potential employersPlease select... 1 2 3 4 5 27. Choose a career that your family does not approve ofPlease select... 1 2 3 4 5 28. Go back to school to get a degree after being out of the militaryPlease select... 1 2 3 4 5 29. Find accurate information about educational programs.Please select... 1 2 3 4 5 30. Choose the area of study you want irrelevant of the competitiveness of that field.Please select... 1 2 3 4 5 31. Change area of study/vocational training if you did not like your first choice.Please select... 1 2 3 4 5 32. Have the ability to successfully take challenging courses.Please select... 1 2 3 4 5 33. Select one major/vocational training from a list of potential majors/vocational training you are considering.Please select... 1 2 3 4 5 34. Apply again to schools after being rejected the first time. Please select... 1 2 3 4 5 35. List several majors/vocational trainings in which you are interestedPlease select... 1 2 3 4 5 36. Determine the academic subject you have the most ability in.Please select... 1 2 3 4 5 37. Attend college or professional school to achieve your career goals.Please select... 1 2 3 4 5 38. Make a plan of your goals after the military.Please select... 1 2 3 4 5 39. Accurately assess your abilities.Please select... 1 2 3 4 5 40. Define the type of lifestyle you would like to live.Please select... 1 2 3 4 5 41. Feel prepared to achieve my goals outside of the military.Please select... 1 2 3 4 5 42. Have a clear vision of what my future could be outside of the military.Please select... 1 2 3 4 5 43. Find a job outside of the military.Please select... 1 2 3 4 5 Additional Questions List your 5 greatest fears in your transition from military to civilian life: List the 5 greatest challenges you face in your transition from military to civilian life: List your 5 greatest strengths: The REBOOT Workshop is free. However, if there were a charge, how would you choose to pay?Please select... With my GI benefit I would personally pay $2,500 Both my GI benefit and out of pocket ($2500) I would not pay Page 4 - Consent to Release Services Provided I give the National Transition Services, Inc. and their partners approved personnel permission to followup with recruiters on my behalf regarding resumes, interviews, and hiring.I Agree to Services Provided Follow Up Agreement Reboot conducts follow up surveys after program completion to determine program effectiveness in achieving our goals. I agree to maintain contact and provide NVTSI (REBOOT) with follow-up information after program completion. This data will be used for internal reporting purposes onlyI Agree Follow Up Newsletter Consent By signing this form I agree to be automatically subscribed to the newsletter and receive updates and request for more information.I Agree to Newletter Photograph and Video Consent to Release I hereby grant the National Veterans Transition Services, Inc. (NVTSI) permission to use my likeness in a photograph or video in any and all of its publications, including web site entries, without payment or consideration.I understand and agree that these materials will become the property of the National Veterans Transition Services, Inc. and will not be returned.I hereby irrevocably authorize the National Veterans Transition Services, Inc. to edit, alter, exhibit, publish or distribute this photo for the purposes of publicizing the National Veterans Transition Services, Inc.’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive my right to royalties or any other compensation arising or related to the use of the photograph.I hereby hold harmless and release and forever discharge the National Veterans Transition Services, Inc. from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.I am 21 years of age and am competent to contract in my own name. I have read this release and I fully understand the contents, meaning, and impact of this release. I Agree to Photo & Video Consent reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. Save my progress and resume later | Resume a previously saved form Contact Information
