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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
B
C
D
E
F

Current Status

Current Status
A
B

Years of Service

Military Occupation

Security Clearance

Security Clearance
A
B
C
D
E

Are you currently Transitioning out of the Military?

Are you currently Transitioning out of the Military?
A
B
C

When do you Separate

When do you Separate
A
B
C
D
E
F

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
B

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
B