Dislocated Worker Survey

Document Number:  DETW-17123

Description:  The Dislocated Worker Survey is to be completed by individuals who are losing or have lost their jobs due to a business closing or mass layoff.  Information from the survey will be used for re-employment, retraining, research and economic development purposes.

Comments:  The form is to be printed and completed by hand and is for distribution only by the DWD and the State's 11 Workforce Development Boards.  Surveys must be printed on plain white paper, front to back so the two pages are on one sheet of paper.  Black or blue pen should be used to complete the survey.  Pencils should not be used.  Workforce Development Boards should send the completed originals 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

Document Attachment:  DETW-17123 (Word/132 KB)

*** 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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