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By completing and submitting this form you'll be added to a distribution list on news and upcoming WorkKeys® events in the Central Pennsylvania region (Centre, Clinton, Columbia, Lycoming, Mifflin, Montour, Northumberland, Snyder and Union Counties).

First Name (required)

Last Name (required)

Mailing Address (required)

City (required)

State (required)

Zip Code (required)

County of Residence (required)

Email Address (enter NA if no email) (required)

Phone Number

Did you take your WorkKeys® assessments in the Central Pennsylvania Region? (required)
 Yes No

If yes, where?
 PA CareerLink® Centre County (State College) PA CareerLink® Clinton County (Lock Haven) PA CareerLink® Columbia/Montour Counties (Bloomsburg) PA CareerLink® Lycoming County (Williamsport) PA CareerLink® Mifflin County (Lewistown) PA CareerLink® Northumberland County (Shamokin) PA CareerLink® Union/Snyder Counties (Selinsgrove)"

If not, please enter location (city and state)

Do you have a Central PA Career Readiness Certificate (CRC) issued by CPWDC? (required)
 Yes No

Do you have a National Career Readiness Certificate? (required)
 Yes No

If you have a CRC or NCRC what level is it? (required)
 Platinum Gold Silver Bronze I did not earn a certificate, but would like to try again.

CPWDC and the PA CareerLink® locations are interested in collecting information on employment obtained by NCRC holders.

Are you currently employed?
 Yes No

If yes:
Employer Name

Did you start this job after you earned your NCRC?
 Yes No

Are you:
 Full Time Part Time Seasonal

Please check all that apply to you:
 I am seeking employment I am receiving assistance from a PA CareerLink® I have attended PA CareerLink® workshops I am receiving unemployment compensation

Are you interested in the closest PA CareerLink® contacting you? (please provide a phone number above)
 Yes No