Thank you for helping build a Certified Work Ready Community.

Please complete the information below submit the form electronically. You may also use the Submit and Print option to print a copy for your records.

You will be contacted by staff once your registration has been processed.

Thank you and GOOD LUCK!

First Name*

Middle Name

Last Name*

Address*

City*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip*

Phone Number*

Second Phone

Email Address

How often do you check your email?*

Several times a day At least once a day 2 to 3 times a week At least once a week

2 to 3 times a month At least once a month Rarely Never

Email is commonly used to communicate regarding this program so please check your email on a regular basis.

Please provide the last four digits of your Social Security Number (used to create your user name and password)*

Birthdate (Optional)

Please indicate your highest level of education.*

GED/HS Diploma Associate Degree Bachelor Degree or Higher

Other Certification Less Than High School

How comfortable are you using computers?*

Not at all Somewhat Comfortable

Very Comfortable

How did you learn about WorkReady Lucas County?*

Email Telephone Website Poster Flier Newspaper

Television Online Ad Facebook Twitter Other

NOTICE: The Lucas County Department of Planning and Development, OhioMeansJobs Lucas County and other one-stop partners make no promise or guarantee of a job upon completion of this program. Individuals who register for the Work Ready Lucas County program will not receive individual case management services or special treatment in any way. Job search is the responsibility of the individual.

I have read and understand this statement.*

Yes

The Lucas County Department of Planning and Development may be asked by employers to verify your completion of this assessment and training program. Specific scores and individual results will be kept confidential. Please check the box below to give your permission to share this information.

I give my permission to the Lucas County Department of Planning and Development to share my information with potential employers. *

Yes

Submitting this document online indicates your desire to participate in Work Ready Lucas County Program and that you agree to the statements checked above.

Click the SUBMIT button to submit your registration form. Select SUBMIT AND PRINT if you would like to keep a copy for your records.