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Fair Chance Job Seekers Interest Form
Submit the following form to get connected to Fair Chance employers with hiring needs. Reach your employment goals and avail of LA County services by getting started on your Fair Chance hiring journey today!
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1
Do you live in Los Angeles County?
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2
Name
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First Name
Last Name
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3
Home Address / Mailing Address
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We'll use this to connect you to the nearest America's Job Center of California.
Street Address
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City
State / Province
Postal / Zip Code
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Israel
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Jamaica
Japan
Jersey
Jordan
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Kiribati
North Korea
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Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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4
Phone Number
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Please enter a valid phone number.
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5
Email
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example@example.com - Application acceptance and communication will be made via email
Confirm Email
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6
Which notification method in which you prefer?
Phone call
Text message
Email
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7
What is your primary mode of transportation?
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Car
Train
Bus
Bike
Walking
Ride Share Apps (Uber, Lyft, etc)
Car rides with family or friends
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8
Tell us what careers paths you are most interested in?
*
This field is required.
Please select the job Sector that interests you the most. This will help us pair you with an employer.
UTILITIES (INCLUDING GREEN ENERGY) (NAICS: 22)
MANUFACTURING (INCLUDING ADVANCED MANUFACTURING) (NAICS: 31-33)
RETAIL TRADE (NAICS: 44-45)
INFORMATION (NAICS: 51)
HEALTHCARE AND SOCIAL ASSISTANCE (NAICS: 62)
ACCOMMODATION AND FOOD SERVICES (NAICS: 72)
CONSTRUCTION (NAICS: 23)
WHOLESALE TRADE (INCLUDING LOGISTICS) (NAICS: 42)
TRANSPORTATION AND WAREHOUSING (NAICS: 48-49)
PROFESSIONAL, SCIENTIFIC, AND TECHNICAL SERVICES (NAICS: 54)
ARTS, ENTERTAINMENT, AND RECREATION (NAICS: 71)
Other
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9
Tell us what careers paths you are most interested in?
Please select the job sector that interests you the most. This will help us pair you with an employer.
UTILITIES (INCLUDING GREEN ENERGY) (NAICS: 22)
MANUFACTURING (INCLUDING ADVANCED MANUFACTURING) (NAICS: 31-33)
RETAIL TRADE (NAICS: 44-45)
INFORMATION (NAICS: 51)
HEALTHCARE AND SOCIAL ASSISTANCE (NAICS: 62)
ACCOMMODATION AND FOOD SERVICES (NAICS: 72)
CONSTRUCTION (NAICS: 23)
WHOLESALE TRADE (INCLUDING LOGISTICS) (NAICS: 42)
TRANSPORTATION AND WAREHOUSING (NAICS: 48-49)
PROFESSIONAL, SCIENTIFIC, AND TECHNICAL SERVICES (NAICS: 54)
ARTS, ENTERTAINMENT, AND RECREATION (NAICS: 71)
Other
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10
In a few sentences, please describe what you hope to gain from participating in the Fair Chance program, what you are most looking forward to in the program, and your dream job.
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11
What type of job would you be interested in?
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12
Please write down any work-related experience that you may have related to your career path choice.
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13
Which locations would you be willing to work in?
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14
Were you referred by any of the following America's Job Centers of California?
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Antelope Valley Comp AJCC
East LA / West San Gabriel Valley Comp AJCC
Pomona Valley Comp AJCC
Rancho Dominguez Comp AJCC
Rio Hondo Comp AJCC
East San Gabriel Comp AJCC
Southeast LA Comp AJCC
South LA AJCC
Not sure / N/A
Other
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15
Are you interested in obtaining LA County services and/or resources?
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YES
NO
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16
How did you hear about the program?
Fair Chance Hiring Launch Event
JCOD’s “A Healing Space” Event
LeadersUp
Root and Rebound
Facebook
Instagram
LA County Website
LinkedIn
Messenger
On-line news site
Pinterest
Radio
Reddit
Referred by someone
Snapchat
Television
TikTok
Tumblr
Twitter
WeChat
WhatsApp
Probation Officer
Social Worker
LA-Tech.org
Opportunity Youth Collaborative (OYC)
Would Works
None of the above
Fair Chance Hiring Launch Event
JCOD’s “A Healing Space” Event
LeadersUp
Root and Rebound
Facebook
Instagram
LA County Website
LinkedIn
Messenger
On-line news site
Pinterest
Radio
Reddit
Referred by someone
Snapchat
Television
TikTok
Tumblr
Twitter
WeChat
WhatsApp
Probation Officer
Social Worker
LA-Tech.org
Opportunity Youth Collaborative (OYC)
Would Works
None of the above
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