Professional Development Plan

1
Name* This field is required.
First Name
Last Name
2
Maiden Name* This field is required.
3
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
County* This field is required.
5
Phone Number* This field is required.
Area Code
Phone Number
6
Gender
7
Date of Birth* This field is required.
Date
Month
Day
Year
8
Current Age
9
Alternate Contact Name* This field is required.
10
Alternate Contact Number * This field is required.
11
Email Address* This field is required.
12
Preferred method of contact:* This field is required.
13
How did you hear about us? Who referred you?* This field is required.
14
Please check all that apply regarding your race:* This field is required.
White
Black or African American
American Indian or Alaskan Native
Asian
Native Hawaiian or Pacific Islander
Unknown/Undisclosed
15
Are you Hispanic/Latino?
YESNO
16
Limited English Proficiency
YESNO
17
Are you attending School?* This field is required.
YESNO
18
What school are you attending?* This field is required.
19
Do you have a high school diploma or equivalency?* This field is required.
YESNO
20
Do you have a degree or certificate?* This field is required.
YESNO
21
What kind of degree or certificate do you have?* This field is required.
22
Are you employed?* This field is required.
YESNO
23
Where are you employed?* This field is required.
24
When did you start your current job?* This field is required.Enter Month, day and year
25
What is your job title?* This field is required.
26
What do you do in your current job?* This field is required.Enter your job duties in the text box below.
Huge
Large
Normal
Small
Ok
Ok
27
What was your last day of work?* This field is required.
Date
Month
Day
Year
28
Name of your most recent employer?* This field is required.
29
When did you start with this employer?* This field is required.
Date
Month
Day
Year
30
What was your job title with your most recent employer?* This field is required.
31
What did you do in your most recent job?* This field is required.Enter your job duties in the text box below.
Huge
Large
Normal
Small
Ok
Ok
32
Have you worked for any other employers in the past?* This field is required.
YESNO
33
What other employment would you like to list on a resume?
Employer Name
Dates of Employment (mm/dd/yyyy)
Job Title
Job Duties
34
Do you have reliable transportation* This field is required.
YESNO
35
When are you available to work?* This field is required.Select all that apply.
Weekdays
Weeknights
Weekends
36
Do you have reliable childcare?* This field is required.
Yes
No
Not Applicable
37
Are there any specific things that are keeping you from finding the job of your choice? * This field is required.
YESNO
38
What are the specific things that are keeping you from finding the job of your choice?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
39
What are the top three occupations you are interested in pursuing?* This field is required.
Occupation 1
Occupation 2
Occupation 3
40
Are you a Veteran or currently active in the Service?* This field is required.
YESNO
41
Start and end date of Service* This field is required.
42
Are you the spouse of a Veteran?* This field is required.
YESNO
43
Are you a child of a Veteran killed in active duty?* This field is required.
YESNO
44
Do you meet one or more of the following?* This field is required.
FoodShare
W2 (TANF)
Homeless
Foster Child
Displaced Homemaker
YOU Receive Free/Reduced Lunch
Ex-Offender
Aged out of Foster Care
None of the Above
45
I am new to the job market.* This field is required.
Yes
No
46
It's been a while since I landed a job or worked.* This field is required.
Yes
No
47
I am unsure if my appearance and/or dress is negatively affecting my job search.* This field is required.
Yes
No
Maybe
48
I have employment experience, and would like to improve my skill set.* This field is required.
Yes
No
49
I have been a supervisor and am seeking to expand my management skills.* This field is required.
Yes
No
50
I am interested in exploring careers in high growth industries in my area.* This field is required.
Yes
No
51
Which of these workshop topics are of interest to you?
Communication
Dependability
Effective Problem Solving
Remaining Focused
Taking Initiative
52
Customer Service Mentor* This field is required.Who did you work with today?
Cassandra Harris
Neal Moore
Alonzo Payne
Diane Ashley
Other
53
Virtual Services* This field is required.Do you have access to a smart phone, lap top or tablet with internet access?
YESNO
54
Virtual Services - Coaching* This field is required.Would you be interested in working with a Virtual Success Coach/Mentor?
YESNO
55
Virtual Services - Workshops* This field is required.Would you be interested in joining online webinars?
YESNO
56
Ask a Career Planner about Online Coahing or the Virtual Workz LIVE Webinars.
57
Signature* This field is required.I certify that the information submitted on this form is true to the best of my knowledge.
Clear
58
Date* This field is required.
Date
Year
Month
Day
59
Before your next appointment go to Job Center of Wisconsin website and register or update your information here.
60
Please take a moment to check out all of the services we offer in the Tour of Services Video:

Career Seekers

You can also type this link into your internet browser:

https://www.sewrks.com/career-seekers
61

Access the 5 minute Countdown Series with SE5MC as the Registration Code/Enrollment Key.

Or, if you already have a Dynamic Works Institute account, log into your account, locate the 5 Minute Countdown - SE WI and enroll with the code above.
62

Access the Industry Scholars with SEWIIS as the Registration Code/Enrollment Key.

Or, type the link below in your broswer window to navigate to the Enrollment Form:

https://www.dynamicinstitute.com/enrollment-registration-form/.
63
To begin your journey with us, complete one of the free interest inventory assessment available to you. Save or print your results and bring them to your next appointment.

Career Locker - register with cdc-c877

Skill Explorer

My Next Move
64
Southeast Wisconsin Workforce Development Board is an equal opportunity employer/program. If you need this information or printed material in an alternate format, or in different language, please contact us at(262)-741-5180. Deaf, hard of hearing, or speech impaired callers can reach us at 800-947-3529 or contact us through Wisconsin Relay Service at 7-1-1.
65
Tags
Todo
In Progress
Done
Should be Empty: