Name:	*
Email:	*
Company:	*
Zip/Postal Code:	*

1. Reason for being in job market? *

Layed-off/downsized Current job dissatisfaction Relocation Retired but needing to work Other:

2. Level of position being sought? *

Entry Level Supervisory Level Middle Management Senior Management Other:

3. Have you reviewed positions on BCW's website? *

Yes No Other:

4. Have you updated your resume in the last year?  (You can submit your resume on BCW's Website - Go To Careers Section) *

yes no Other:

5. When is the last time you were in the job market? *

Less than a year One - four years Five years or more Other:

6. How soon do you need a job? *

Immediately In the next six months - year I'm flexible Other:

7. What are your immediate needs to begin or accelerate your job search? *

Resume development/critique Assistance organizing my job search Practice interviews/haven't done it in a while Help trying to figure out what I want to do Access to job leads Support - I hate feeling so scared, confused, angry, alone Other:

8. Would you be willing to be a part of a job search group, specifically for black women, that meets monthly  (in person or even on-line via a BCW Job Seekers Chat Room) to provide mutual support and information? *

Yes No Maybe Other:

9. What community or work resources are you/or have you used in your job search? *

10. Are you willing to relocate? *

yes No Maybe Other:

11. List two job titles that are of particular interest to you that you feel you should be able to qualify for: *

12. What else can you tell us that would assist BCW in making this job search program most helpful to you? *

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