MI Works SW Intake

First Name

Last Name

Date of Birth

Phone Number

Purpose of visit (select all that apply)

Apply for unemployment benefitsRegister for work for unemployment benefitsTalk to staff about unemployment benefitsAttend workshopAttend jobs fair or employer of the day eventLook for jobTalk to staff about job searchUse the computer, copier, or fax machinePATHPre-employment assessment (such as GED Prep, ParaPro, WorkKeys)Other. Please specify

Specify Purpose of visit

Which Michigan Works! office location are you at?

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