Rapid Response Questionnaire

You may be eligible for additional free re-employment services under the Workforce Innovation and Opportunity Act.  If you would like to attend a Rapid Response Team webinar to learn more about these opportunities, please complete the information below:

IMPORTANT NOTE: Before submitting this form please verify that all required information is fully completed.

Please be advised that your completion of this questionnaire is not related to filing a new claim for unemployment benefits.

* - required field

* Full Name  

* Street Address:  

* Town, State, Zip Code:  

*Email Address:  

Was your layoff due to increased imports, foreign competition, or a shift of work to another country? 

  Yes   No Not Sure

Last Employer Information 

  • Name of Last Employer  
  • Job Title  


*Reason for Layoff: