Registration for Services

Thank you for expressing interest in our programs. Please fill out this short registration form and take the next steps toward your new career. If you need help completing this form, please contact us at 973-674-6330 or email info@jvsnj.org.

First Name(Required)

Last Name(Required)

Birthdate(Required)

MM slash DD slash YYYY

Address Line 1(Required)

Address Line 2

City(Required)

State(Required)

Zip code(Required)

Contact Phone Number(Required)

Email Address(Required)

Primary Language(Required)

Do you have a High School Diploma or GED from the US or other country?(Required)

Yes

Are you authorized to work in the United States?(Required)

Yes

Do you need JVS assistance in finding a job?(Required)

Yes

Are you currently employed?(Required)

Yes

Do you receive SNAP benefits or are you SNAP-eligible?(Required)

Yes

Do you currently receive any services at JVS or have you received any services from JVS in the past?(Required)

Yes

If "Yes," please list which services you received from JVS?

You may qualify for a Lifelong Learning Account (Job Seeking Support) through the State of NJ. To determine your eligibility, please indicate your household income.(Required)

To qualify for a Lifelong Learning Account (Job Seeking Support) through the State of NJ, please indicate the number of people in your household:(Required)

What are you interested in? (Check all that apply. Can select multiple.)(Required)

GED classes

Career Services (Help finding a job or career path)

Certified Apartment Maintenance Technician Training

Certified Home Health Aide Training

Citizenship Classes

English as a Second Language (ESL) Classes

Jobseekers Programs & Networking

LILA (Lifelong Learning Accounts)

Pharmacy Technician Training

Pre-Apprenticeship Pharmacy Technician Training

Refugee Services (Assistance to refugees, parolees, and political asylees)

School to Career Transition Services (14-21 years old for individuals with disabilities)

Student Loans & Grants

Vocational Services for People with Disabilities

SNAP Education & Training (SNAP STEPS)

A beneficiary agency of:

An affiliate agency of:

Accredited by: