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Are you a U.S. citizen and/or legally authorized to work in the U.S.A.? (required) Select Value Yes No Are you a current resident of the State of Florida (required) Select Value Yes No First Name (required) Middle Name Last Name (required) Email (required) Create Account Password (For Future Login) (required) Cell Phone (required) Street Address (required) Apt #/Unit #, if applicable City (required) State (required) AB - Alberta AK - Alaska AL - Alabama AR - Arkansas AS - American Samoa AZ - Arizona BC - British Columbia CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida FM - Federated States of Micronesia GA - Georgia GU - Guam HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MB - Manitoba MD - Maryland ME - Maine MH - Marshall Islands MI - Michigan MN - Minnesota MO - Missouri MP - Northern MarianaIs. MS - Mississippi MT - Montana NB - New Brunswick NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NL - Newfoundland and Labrador NM - New Mexico NS - Nova Scotia NT - Northwest Territories NU - Nunavut NV - Nevada NY - New York OH - Ohio OK - Oklahoma ON - Ontario OR - Oregon PA - Pennsylvania PE - Prince Edward Island PR - Puerto Rico PW - Palau QC - Quebec RI - Rhode Island SC - South Carolina SD - South Dakota SK - Saskatchewan TN - Tennessee TX - Texas UT - Utah VA - Virginia VI - Virgin Islands VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming YT - Yukon Zip (required) County (required) Select Value Seminole Orange Volusia Osceola Lake Polk Who referred you to Christian HELP? (required) Select Value CFEC Website Church Client of Christian HELP Employee of Christian HELP Family Member Friend Hope Helps Internet Jail Program Job Fair Volunteer of Christian HELP Other Please rate your level of English (required) Select Value Excellent Good Fair Poor Employment Status (required) Select Value Unemployed Employed Underemployed Retired Other Do you have any crime convictions? (required) Select Value None Misdemeanor Felony Your current/last job title held? (required) Dates of last employment? (required) Wages of last employment (per hour)? Wages of last employment (per month)? Wages of last employment (per annum)? Current Household Income (per year) (required) Select Value Under $20K $20K - $35K $35K - $50K $75K - $100K Over $100K Do you have access to reliable transportation to and from work? (required) Select Value Yes No Highest Level of Education (required) Select Value Doctorate (PHD) Graduate (Masters) Undergraduate (Bachelors) Associates Degree Technical School Certification High School Diploma GED High School No Diploma No Schooling Completed Is the employment you are looking for? (required) Select Value Full-time with benefits Full-time Part-time Seasonal Other Employment Industries 1) Healthcare & Social Assistance a. Examples: Nurses, Physicians, therapists, social workers, counseling 2) Technology & Professional Services a. Examples: Software engineer, technician, data scientist, consultants, Administrative assistant 3) Retail & Hospitality a. Examples: Restaurants, hotels & travel employees, sales, chefs, event planning, Customer Service roles 4) Education & Governmental Services a. Examples: teacher, professors, government roles, law enforcement 5) Manufacturing & Construction a. Example: Warehouse laborers, contractors, electrician, engineers, construction, Shipping, Inventory Managers 6) Finance & Business a. Example: Accountants, insurance agents, auditor, financial, operations manager 7) Other What type of employment are you currently searching for? (required) Select Value Healthcare & Social Assistance Technology & Professional Services Retail & Hospitality Education & Governmental Services Manufacturing & Construction Finance & Business Other What is your biggest challenge in your job search? Resume Interviewing Networking Branding Elevator Pitch Job Search Tactics Other Gender (required) Select Value n/a Male Female Gender Questioning Gender-fluid Intersex Person Non-Binary person Transgender Man Transgender Woman Other Choose not to disclose Current Living Situation (required) Select Value Rent Mortgage Owner Street Car Shelter Section 8 Temporary Friends or Family Permanent Friends or Family Transportation Method (required) Select Value Vehicle Shared Vehicle Rely on others Bus Bike Walk Other Birth Date (required) Race (required) Select Value Black White Islander Asian Hispanic (required) Select Value Yes No Nationality (required) Select Value Afghan Albanian Algerian American Andorran Angolan Antiguans Argentinean Armenian Australian Austrian Azerbaijani Bahamian Bahraini Bangladeshi Barbadian Barbudans Batswana Belarusian Belgian Belizean Beninese Bhutanese Bolivian Bosnian Brazilian British Bruneian Bulgarian Burkinabe Burmese Burundian Cambodian Cameroonian Canadian Cape Verdean Central African Chadian Chilean Chinese Colombian Comoran Congolese Costa Rican Croatian Cuban Cypriot Czech Danish Djibouti Dominican Dutch East Timorese Ecuadorean Egyptian Emirian Equatorial Guinean Eritrean Estonian Ethiopian Fijian Filipino Finnish French Gabonese Gambian Georgian German Ghanaian Greek Grenadian Guatemalan Guinea-Bissauan Guinean Guyanese Haitian Herzegovinian Honduran Hungarian I-Kiribati Icelander Indian Indonesian Iranian Iraqi Irish Israeli Italian Ivorian Jamaican Japanese Jordanian Kazakhstani Kenyan Kittian and Nevisian Kuwaiti Kyrgyz Laotian Latvian Lebanese Liberian Libyan Liechtensteiner Lithuanian Luxembourger Macedonian Malagasy Malawian Malaysian Maldivian Malian Maltese Marshallese Mauritanian Mauritian Mexican Micronesian Moldovan Monacan Mongolian Moroccan Mosotho Motswana Mozambican Namibian Nauruan Nepalese New Zealander Ni-Vanuatu Nicaraguan Nigerian Nigerien North Korean Northern Irish Norwegian Omani Pakistani Palauan Palestinian Panamanian Papua New Guinean Paraguayan Peruvian Polish Portuguese Qatari Romanian Russian Rwandan Saint Lucian Salvadoran Samoan San Marinese Sao Tomean Saudi Scottish Senegalese Serbian Seychellois Sierra Leonean Singaporean Slovakian Slovenian Solomon Islander Somali South African South Korean Spanish Sri Lankan Sudanese Surinamer Swazi Swedish Swiss Syrian Taiwanese Tajik Tanzanian Thai Togolese Tongan Trinidadian or Tobagonian Tunisian Turkish Tuvaluan Ugandan Ukrainian Uruguayan Uzbekistani Venezuelan Vietnamese Vincentian Welsh XXX Yemenite Zambian Zimbabwean Marital Status (required) Select Value Married Single Separated Divorced Widowed Household Type (required) Select Value Adults and Children Under 18 Adults (over 18) Only Single Male Single Female Number of adults in your household including yourself? (required) How many children under 18 are in your household? (required) U.S. Veteran? (required) Select Value Yes No When you request services through Christian HELP, we may connect you to partner community and faith organizations through The NewOrg software to work together in order to holistically address your needs and provide you with effective services. This release of information is written consent that upon your request, we may share your information with other service providers or agencies. I understand that: This agency will refuse to serve me simply because I do not want my information in their database system and may share with other service agencies at my request. My written consent gives Christian HELP and NewOrg Management System software the permission to share limited personal information in their database system, which is a secure, encrypted web-based system. My information can only be shared with other The NewOrg software Partner Agencies within the secure system. All organizations using the The NewOrg Management System software database are required to have security procedures in place regarding the protection and sharing of all client data. I have been assured that The NewOrg software has an interagency agreement regarding shared data. This authorizes select information about me to be used to conduct research reports on the various types of resources, characteristics of those utilizing services, effectiveness of the services and patterns over time. I will not be personally identified by name, social security number or other unique characteristics in the research reports. Image or Video Release I authorize Christian HELP to use elements of my story, my photographs or video for media print and online advertising. I understand that my name will not be used in my story without my further permission, nor will I be compensated for my photographs or videos. Release of Information/Consent/Image+Video Release (required) Select Value I agree Release of Information/Consent/Image+Video Release Date (required) Submit
