Connecticut Platform to Employment (P2E) Application
RequiredRequired Question(s)

P2E is open to individuals from the state of Connecticut who have been unemployed 27 or more weeks and have exhausted their unemployment benefits.


Please complete this application. Answer all questions, including contact information. Many people leave contact information blank. We can not contact you if this information is missing. If selected to move to the next level in the process, you will receive an email or call to set up an interview. Only participants who receive emails or calls will be considered for advancement. It is important to check email and voice-mail during this time period. If we cannot reach you, you will not be considered. Please do not call to inquire about your application status.  



 
Required 1.

Please enter the information indicated below. Under Phone 2, please list your mobile number if applicable



First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:
Cell Phone:
Phone 1:

Required 2.

Date of Birth

 

50 characters left.
Required 3.
Gender
Male
Female
Other  
Required 4.

Please select the training location most suitable in terms of geography. 

Bridgeport
Waterbury
New Haven
Hartford
Norwich
Required 5.
Are you authorized to work in the United States? 
Yes
No
Required 6.

What is your unemployment benefit status?

Currently Collecting
Exhausted My Benefits
Have Not Received Benefits
Required 7.

If you selected "Currently Collecting" from the question above, please indicate the date when your benefits will expire. 

 

50 characters left.
Required 8.
How long have you been unemployed? Please indicate months. 
 

50 characters left.
Required 9.

What was your last day of employment? Example: 12/13/17

 

50 characters left.
Required 10.
 Are you a Veteran?
Yes
No
11.
Have you registered with Selective Service? (For Males only)  
Yes
No
Not Applicable
Not sure if I ever registered
Required 12.

Do you have any means of income in addition to unemployment insurance (select all that apply)? 

Social Security
Pension
Disabilty
Alimony
Savings/Investments
Spouse/Other household adult
Food stamps
Other  
Required 13.

What is your current total annual household income from all sources?

 

50 characters left.
Required 14.

What is your household size? 


1
2
3
4
5 or more
Required 15.
Is there another adult in your household (over 21) who is employed? If yes, are they employed full-time or part-time?
Yes. If yes, indicate below if it is part-time or full-time.
No
  • Comment:

  • 500 characters left.
Required 16.
What was the name of your last employer?
 

50 characters left.
17.

What was the job title at your last employer?  

 

50 characters left.
18.

How many hours did you work at this position per week?

 

50 characters left.
Required 19.

What were your annual earnings from your previous employer?

$0 to $10,000
$10,001 to $20,000
$20,001 to $30,000
$30,001 to $40,000
$40,001 to $50,000
$50,001 to $60,000
$60,001 to $70,000
$70,001 to $80,000
$80,001 to $90,000
$90,001 to $100,000
More than $100,000
Required 20.
How long were you employed in your last position?
 

50 characters left.
Required 21.
What was the reason for the separation? 
Laid Off
Terminated
Left voluntarily
Company Closed/Moved
Other  
Required 22.

What was your primary occupation?

Architecture and Engineering Occupations
Arts, Design, Entertainment, Sports, and Media Occupations
Building and Grounds Cleaning and Maintenance Occupations
Business and Financial Operations Occupations
Community and Social Services Occupations
Computer and Mathematical Occupations
Construction and Extraction Occupations
Education, Training, and Library Occupations
Food Preparations and Serving Related Occupations
Healthcare Practitioners and Technical Occupations
Healthcare Support Occupations
Installation, Maintenance, and Repair Occupations
Legal Occupations
Management Occupations
Office and Administrative Support Occupations
Personal Care and Service Occupations
Production Occupations
Protective Service Occupations
Sales and Related Occupations
Transportation and Material Moving Occupations
Other  
Required 23.

 What is the highest level of education you completed?    

Did not complete high school
High School Diploma/GED
Associate Degree
Bachelor
Masters
Doctorate
State Recognized Apprenticeship Program
Required 24.

How many hours a week do you spend seeking full-time employment?

Less than 8
9-16 hours
17-24 hours
25-32 hours
33-40 hours
40+ hours
Required 25.

Do you have a current resume?

Yes
No
Required 26.
How many job interviews have you had in the past 6 months? Count in-person and telephone interviews.
 

50 characters left.
Required 27.
Keeping track of your job search is mandatory during the Platform to Employment program. Please describe how you currently keep track of your search efforts. 
Example: Excel spreadsheet, Word document, notebook etc. 
 

350 characters left.
Required 28.

What types of jobs have you submitted resumes to? 

 

350 characters left.
Required 29.

How often do you use the following resources during your job search?

 Never Not Often Sometimes Regularly  
Job Search Websites  
Placement Agencies  
Cold Calling  
Professional Network  
Personal/Social Network  
Employee Referrals  
School Alumni Groups  
Required 30.

If you were offered a full-time position, what starting salary would be acceptable?

Less than $20,000
$20,001 to $30,000
$30,001 to $40,000
$40,001 to $50,000
$50,001 to $60,000
$60,001 to $70,000
$70,001 to $80,000 +
Required 31.

How far are you willing to travel for work (one-way)?  

0-20 miles
21-30 miles
31-60 miles
Required 32.

What is your primary means of transportation? 

Bus
Car (own)
Car (relative/friend)
Train
Walk
Other  
Required 33.

Have you ever received services at an American Job Center? If so, what type of service(s). Select all that apply. 

Occupational Skills Training
Job Search Assistance
Community Program
Computer Lab
Workshop
Have Not Received Services
34.

If yes to #34, please specify which location you received services:  

Derby
Waterbury
Bridgeport
Torrington
Stamford
New Haven
Hartford
Other  
Required 35.

During this period of unemployment, have you returned to school or taken further training? If the answer is yes, please explain the academic program or training.

Yes
No
  • Comment:

  • 500 characters left.
Required 36.

Please describe any volunteer service, unpaid internships and/or other activities you have been engaged in during this period of unemployment.  

 

350 characters left.
Required 37.
Are you currently registered with LinkedIn to assist in your job search?
Yes
No
Required 38.

P2E is an intensive five week training course that assist job seekers. During the training and upon completion you will be assisted in your job search and potentially placed with an employer who will be eligible to receive a wage subsidy. Tell us briefly your motivation to participate in this program as well as your expectations.

 

1000 characters left.
Required 39.

What are your weaknesses as they relate to job search? 

 

350 characters left.
Required 40.

Please rate your urgency to get back to work based on the options listed 

 Immediately Next 30 days Next 60 days Next 90 days Other - Please Explain 
Urgency to Return to Work
  • Comment:

  • 500 characters left.