Dislocated Worker Survey

Document Number:  DETW-17123

Description:  The Dislocated Worker Survey is completed by individuals who may lose or have lost their jobs due to a business closing or mass layoff.  Information gathered in this survey is used for re-employment, retraining, research and economic development purposes.

Comments:  The survey form is distributed only by DWD and Wisconsin's 11 Workforce Development Boards.  The survey is completed by hand using a black or blue pen.  Pencils should not be used.  Workforce Development Board representatives return the completed surveys to:

Department of Workforce Development
Division of Employment and Training
Dislocated Worker Unit, GEF 1 - E100
201 E. Washington Ave.
P.O. Box 7972
Madison, WI 53707

Content Contact:  Gesina Mentink

*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.

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