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COMMONWEALTH OF VIRGINIA
DEPARTMENT OF SOCIAL SERVICES
SNAP EMPLOYMENT AND TRAINING
(SNAP E&T) ☐ Assessment ☐ SNAP E&T ☐ Reassessment ☐ TANF/VIEW ☐ TANF-UP/VIEW VDSS Employment Services Program Assessment Form Name
Case Number
Date
Phone Number(s)
Primary Language
Do you need an interpreter? Yes ☐ No ☐
Instructions: The information you give us in this document is confidential and asked only to help us better assist you on the path to self- sufficiency. Please do your best to answer as many questions as you can. If you cannot answer a question, then please skip it and your worker will discuss it with you when you meet. Also, please make sure to bring this document with you to your appointment.
Do you have access to a computer with internet? Yes ☐ No ☐ Have you registered in Virginia Workforce Connection (www.vawc.virginia.gov)? Yes ☐ No ☐ Are you registered with Virginia Career Works (https://va-career-works.myjourney.com)? Yes ☐ No ☐
Consideration in employment planning: Which of the following do you have to think about when finding and/or keeping employment/training/education? (Check all that apply): ☐ Childcare ☐ Transportation ☐ Housing Situation ☐ Health ☐ Job Skills/Experience ☐ Education ☐ Family Situation ☐ Financial Situation ☐ Legal/Criminal Status ☐ Family Abuse* ☐ Substance Abuse ☐ Limited English ☐ Other
*The Family Violence Hotline can be reached at 1-800-838-8238.
(A) CHILDCARE Do you have reliable childcare? Yes ☐ No ☐ N/A☐ Do you need help getting childcare? Yes ☐ No ☐ If relying on one person for childcare, what is your back-up childcare if the person is unavailable?
(B) TRANSPORTATION Do you have a driver’s license? Yes ☐ No☐ If no, are you interested in getting your license? Yes ☐ No ☐ Is your license suspended? If so, why?
Do you own a vehicle? Yes ☐ No☐ Is it reliable? Yes ☐ No ☐ What is your usual method of transportation (bus, bike, walking, a friend, etc.)?
032-22-1090-01-eng