(845) 249-4634 Monday - Friday 8:30 am to 4:30 pm     

Dutchess County Career Center Customer Registration Form

Auxiliary aids and services are available upon request to individuals with disabilities. Once you complete and submit the form you will receive an email copy for your records.


Customer Data
Are you a US Citizen?
If no, are you authorized to work in the US?

Note: The Ethnicity and Race questions are voluntary. Information is confidential and will only be used for record keeping and affirmative action requirements. You will not be penalized if you do not want to answer. 
Ethnicity Race
(Check all that apply)

(select highest level completed)
If college, check all that apply
Are you attending a secondary, post-secondary, vocational, technical or academic school full-time?
If you are between terms, do you intend to return to school?

Veterans and "eligible spouses" receive priority of service.
Did you serve in the United States Armed Forces?
Are you an eligible spouse of a veteran?
If you're a male born after Dec 31, 1959, are you registered with the US Military Selective Service?

Are you currently employed?
If Yes, are you employed

Employment Preferences
Work Week
Check your work preferences
Which shifts are you willing to work?
Check all that apply
Are you a migrant or seasonal farm worker?

Employment Objective
Employment objective/Type of work you are seeking
List most recent occupation(s)/job(s)

Acceptable Job Locations
I am willing to work within the following zip code, county or state (check the number of miles and write the zip code)
Number of Miles

Work History
Most recent job held first

Additional Work History
Next most recent job held

Driver's License
Do you have a driver's license?
Do you need public transportation to get to a job?
Do you have reliable transportation to and from work?

Do you have an occupational certificate or license?
Additional Certificate or License
Do you have an occupational certificate or license?
Additional Certificate or License
Do you have an occupational certificate or license?

Do you have a college degree, diploma or educational certificate?

List at least one. 
Include skills and abilities that you used in your job(s), volunteer work, personal experiences, or that you have acquired through school or training. Examples: laboratory techniques, carpentry, welding, ability to read blueprints, typing, and computer skills such as word processing software, programming languages, or computer assisted design. Also, include languages in which you are fluent. 
I certify that the information given on this document is true and accurate to the best of my knowledge.