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Employment and Training Services Referral Form

  1. Employment and Training Services Form

    Please complete this form and a staff member will be in contact with you. If you would like more information, please call any Orange County DSS location at (919) 245-2800 or NC Works/ Skills Development Center at (919) 245-4335.

  2. JOB SEEKER INFORMATION

  3. REFERRAL SOURCE

  4. Veteran?

  5. Do you receive Public Assistance? If so, please indicate which:

    Check all that apply

  6. Services of Interest

    Check all that apply

  7. Challenges to Employment/ Training

    Check all that apply

  8. Leave This Blank: