Dislocated Worker Survey
Document Number: DETW-17123-E
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 manually completed by hand. The survey completion date, employer name and employer location may be entered prior to printing.
Content Contact: Gesina Mentink
DETW-17123-E (English Electronic Version - Word/128 KB)
DETW-17123-E-H (Hmong Electronic Version - Word/134 KB)
DETW-17123-E-M (Somali Electronic Version - Word/132 KB)
DETW-17123-E-S (Spanish Electronic Version - Word/353 KB)
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