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Intake and Orientation Registration Form

Welcome to the Online MSW Employment and Training Services Intake and Orientation Registration Form

The information you provide will be sent directly to our office. Once you’ve completed the form, you will receive both an email and a text message with your scheduled orientation date.

After attending the orientation, you will be connected with a Counselor who will assist you in determining your eligibility for services. Please be aware that being found eligible does not automatically guarantee access to services or training.

We kindly ask for your patience throughout this process, as it may take 4 to 6 weeks to determine eligibility. Our resources are limited, and we aim to support as many eligible residents as possible within Morris, Sussex, and Warren counties.

If you are not a resident of Morris, Sussex or Warren County, please do not fill out this form.  You will need to contact the One Stop that is located within the county that you reside in.  

Thank you for your understanding and cooperation.  If you have any questions please contact us at msw-ets@co.morris.nj.us or 973-285-6880.

The following information is required:

  • Contact information, including your legal name (not your nickname) and last four digits of your social security number
  • If you are a permanent resident, your alien registration number and the expiration date
  • If you are enrolled in Selective Service, your Selective Service number
  • Military Service information/status (if applicable)
  • Information about your last place of employment (if applicable)

Please fill in all of the information at one time. The online form cannot be saved while in progress.

Allow about 10-15 minutes to complete this form.

To successfully complete the online form, you will then be required to sign and submit.

Let’s start by clicking or tapping on the "Next" button.

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Date of Birth

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What sex were you assigned at birth on your original birth certificate?

What is your gender identity?

Ethnic Heritage

Race (Select all that apply)

Native Language (If not English, please enter language into the text field box below)

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Contact Information

Current Address (Please input apartment, suite, etc. information on the second line.)

Primary Phone Number Type

Secondary Phone Number Type

Contact Preference

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Are you currently attending a high school or alternative school?

If you're attending high school:

If you're not attending school:

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Marital Status

Family Household/Status

Are you currently: (Select all that apply to you)

Are you currently receiving: (Select all that apply to you)

Housing

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US Citizen (Current Status)

Expiration Date

Are you enrolled in Selective Service (Males born on or after 1/1/1960 only)?

Have you served in the military?

Start Date of Service

Last Date of Service (Please enter today’s date if currently on active duty)

Service Disability

Campaign Veteran

Type:

Receiving Veteran’s benefits or assistance?

Military Spouse – Are you:

If yes, has your income been affected by spouse’s deployment?

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Employment Information

Employment Status

If employed:

If employed - received notice of termination:

If not employed and homemaker:

Are you a migrant seasonal farmworker?

What type of farmworker are you?

Farmwork type:

Do you have a work history (including current employer)?

Please let us know the following about your most recent employer:

Employer Address (Please input apartment, suite, etc. information on the second line.)

Start Date (Please select the first day of the month if uncertain about the exact start date)

End Date (Please select the last day of the month if uncertain about the exact end date)

Reason for Leaving

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Employment Preferences

Work Week:

Duration:

Shift Preferences - are you willing to work any shift?

If No, which shift(s)?

Available Start Date

Preferred job location: Miles from Zip Code

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Transportation Information

Do you own a vehicle?

Do you currently have auto insurance?

Is transportation available to you? (Select all that apply)

Do you have a valid driver's license?

Type of license(s):

Endorsements (Select all that apply)

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Do you have any Certificates or Special Licenses?

Issue Date

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Offender Status - Have you been convicted of a crime?

Do you believe this is a barrier to employment or training?

Do you have a disability?

Please continue to answer all of the questions and then submit the online application.

Once submitted, ask our staff for Form D.  [Form D is kept confidential.]

Do you feel you have any barriers to employment, including customs, practices or beliefs, not described on this form, which you wish to disclose?

Please upload of a copy of your resume (if available)

Click Here to Upload
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What services do you need? Select all that apply:

Referral Source

Please select a date that works with your schedule to attend a virtual Training Orientation. You will receive a confirmation email 5 to 7 days before your orientation date and a text confirmation.

Have you ever received training in the past from MSW Employment and Training?

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Sign and Complete the Form

I attest that the information provided is true and accurate; any misrepresentation may be grounds for termination from program(s). I further understand that being determined eligible for services and/or training does not necessarily entitle me to service/training.

Applicant Legal Signature

Applicant Legal Signature
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