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Veteran Intake Form
Name
*
Email
Phone Number
*
Preferred Method of Contact
*
Preferred Method of Contact
Branch of Service
*
Branch of Service
A
Air Force
B
Army
C
Coast Guard
D
Marine Corps
E
Navy
F
Space Force
Current Status
*
Current Status
A
Active Duty
B
Veteran
Years of Service
*
Military Occupation
*
Security Clearance
*
Security Clearance
A
Public Trust
B
Secret
C
Top Secret
D
Top Secret/SCI
E
No Clearance
Are you currently Transitioning out of the Military?
*
Are you currently Transitioning out of the Military?
A
Yes
B
No
C
Already Separated
When do you Separate
*
When do you Separate
A
Within 30 Days
B
1 to 3 months
C
3 to 6 months
D
6 to 12 months
E
> 1 Year
F
Already Separated
What is your biggest challenge right now?
*
Do you agree to be contacted by VetConnect Staffing regarding services, opportunities, and next steps?
*
Do you agree to be contacted by VetConnect Staffing regarding services, opportunities, and next steps?
A
Yes
B
No
I understand that submitting this form does not guarantee job placement, VA benefits approval, or a specific outcome. VetConnect Staffing will review my information and recommend next steps based on the information provided.
*
I understand that submitting this form does not guarantee job placement, VA benefits approval, or a specific outcome. VetConnect Staffing will review my information and recommend next steps based on the information provided.
A
I understand
B
I don't understand
Submit
